Monitors the medical treatment to ensure quality, effective, and cost-efficient care.
Conducts comprehensive evaluations of disability claimants' functionality via functional assessments.
Independently reviews and interprets clinical information and utilizes established clinical guidelines and protocols.
Drives crisis support initiative for the disability organization by assessing crisis situations.
Advises on highly complex claims at multidisciplinary clinical review roundtables.
Determines when claims contain quality of care issues and escalates through established channels.
Independently conferences with treating providers and/or other higher level facilities.
Leverages resources such as vocational rehabilitation, risk management unit, physician reviews, etc.
Manages risk and resources on highly complex behavioral health claims.
Identifies appropriate return to work options and/or barriers.

3-5 years of direct clinical practice experience post master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
Case management and discharge planning experience preferred
Managed care/utilization review experience preferred
Crisis intervention skills preferred
Licensed independent Behavioral Health clinician in state of service with unrestricted license.
Minimum of a Master’s degree in Behavioral/Mental Health or related field.
Registered nurse with active licensure; with behavioral health/mental health experience.

Behavioral Health Case Manager

Key skills