Care Manager

Company Name:
ValueOptions, Inc., a Beacon Health Options company
ValueOptions, Inc., a Beacon Health Options company
ValueOptions is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled.
Position Location: MD - Linthicum
AAP Reporting Location: MD - Baltimore
ID: 33021
Job Family: Clinical, Licensed
FTE Status: Full time
Scheduled Weekly Work Hrs: 40
Workday Schedule: Weekdays Only
Workday Start Time: 8:00
Workday End Time: 5:00
Variable Work Schedule:
We are currently seeking a dynamic Care Manager to join our team at our office in Linthicum, Maryland. The Care Manager provides brief telephone assessments, referrals, and counseling. Conducts telephone assessments, collecting sufficient data to make appropriate referral and authorization decision for emergency, urgent, and routine levels of care. Makes appropriate utilization management decisions. Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible. (This position will be through a subcontractor agency.)
Position Responsibilities:
Provide brief telephone assessments, counseling, and referrals to consumers in crisis. Gather demographic and clinical information during telephone assessments to better connect consumers with appropriate providers of urgent and non-urgent levels of care.
Conduct clinical assessments of requests for authorization that are received via telephone, fax, and the secure, on-line "Connect" systems.
Collect sufficient data to make appropriate referrals and decisions for emergent, urgent, and routine levels of care. Apply utilization management policies and procedures for determination of initial, concurrent and retrospective reviews for all levels of care in the Public Mental Health System of Maryland. Seek clinical consultation with Clinical Management and Peer Advisors when appropriate.
Make appropriate utilization management decisions by evaluating the clinical appropriateness of the requested treatment plan; using sound clinical judgment and the State of Maryland Public Mental Health System's Medical Necessity Criteria. Collaborate with providers, Core Service Agencies, and Managed Care Organizations to determine alternate levels of care and to assure continuity of care.
Seek peer advisor consultations for quality of care concerns, utilization outliers, and adverse determinations.
Follow workflows associated with identifying/managing provider and consumer utilization outliers.
Fully address provider complaints/concerns in a timely manner.
Develop and maintain flexibility regarding fluctuations in case volume and assist in completing special projects as assigned.
Position Requirements:
Education : A minimum of a BS Degree in a mental health field or an Associate's Degree in Nursing with related psychiatric nursing experience.
Licensure : This position requires a current valid and unrestricted license in Maryland in a mental health field (RN, LCSW-C, LCPC, LMFT, LCADC, etc.)
Relevant Work Experience: Minimum of 3 years experience in psychiatric and/or substance abuse treatment. Experience in settings that include Inpatient, Residential, Partial Hospitalization, and other intensive levels of care are encouraged.
Knowledge, Skills & Abilities :
Basic computer skills required, including Microsoft Word and Excel
Strong customer service orientation
Strong written and verbal communication skills

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