Care Manager BH (Onsite, PA, Hollidaysburg)
Core
Authorizes and reviews utilization of mental health and substance abuse services for inpatient and outpatient care settings, ensuring medical necessity and effectiveness.
Role type
Senior clinical care manager (behavioral health)
Builds
Utilization management decisions and care coordination plans for behavioral health members
Domain
Behavioral health / Mental health / Substance abuse
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Utilization management, discharge planning, crisis intervention, concurrent reviews, quality improvement analysis, network development, DSM-V knowledge
Preferred skills
Community resource knowledge, provider interaction, alternative treatment planning
Technologies
None stated
Responsibilities
Monitor inpatient/outpatient level of care services; provide telephone triage and emergency authorizations; perform concurrent reviews; develop and oversee discharge plans; conduct quality clinical reviews; interact with Physician Advisors; participate in quality improvement activities; advocate for patient treatment needs; propose alternative treatment plans when necessary.
Seniority
Mid-level, hands-on IC