Seven Fields, Pennsylvania, United States of America
Full Time
2 weeks ago
Visa Sponsor
About this role
Role Overview
Serves as a resource for medical management programs
Identifies and recommends revisions to policies/procedures
Ensures staff adheres to accreditation guidelines
Supports quality improvement activities
May assist with implementation of cost of care initiatives
May attend meetings to review UM and/or CM process and discusses facility issues
Hires, trains, coaches, counsels, and evaluates performance of direct reports
Manages a team of licensed clinicians and non-clinical support staff to ensure medical necessity and appropriateness of care for inpatient/outpatient BH services
Engages in telephonic outreach to members
Monitors and evaluates the effectiveness of care plans; manages case consultation and education to customers and internal staff for efficient utilization of BH services.
Requirements
Requires MA/MS in social work, counseling or a related behavioral health field, or a degree in nursing
Minimum of 5 years of clinical experience with facility-based and/or outpatient psychiatric and chemical dependency treatment
Prior utilization management experience
Requires a current active unrestricted license such as LCSW, LMHC, LICSW, LPC, LMFT, RN or Clinical Psychologist to practice as a health professional from the Commonwealth of Pennsylvania
Extensive experience in case management and telephonic and/or in person coaching with members with a broad range of complex psychiatric/substance abuse and/or medical disorders required
Managed care experience required
Behavioral Health treatment strongly preferred
Experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment strongly preferred