Behavioral Health Case and Utilization Manager
Status: Full-time, Exempt: Yes
This position makes triage and referral decisions requiring clinical judgement. The individual will follow members for mental health , substance abuse and co-morbid medical disorders according to the benefit guidelines and policies across the continuum of care. The Behavioral Health Case and Utilization Manager will review all requests for inpatient services in view of the appropriate BH and MVP standards, such as Interqual and OCADTR guidelines, assuring that appropriate follow up of outpatient services occur. The Behavioral Health Case and Utilization Manager will provide case management/care coordination for members to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual’s behavioral health needs. The Behavioral Health Case and Utilization Manager will review requests for all outpatient care plans for both
mental health or substance services, using MVP’s Utilization Management programs for entering and tracking cases, correspondence, and documentation. In addition, the
Behavioral Health Case and Utilization Manager will conduct retrospective review of inpatient/outpatient cases and reviews as needed, with supervisors or medical directors.
The Behavioral Health Case and Utilization Manager will share after hours and weekend on-call responsibilities. The Behavioral Health Case and Utilizatiaon Manager may be required to make site visits to providers or to facilities to attend team meetings to assist in developing
relationships and safe, effective alternative service settings. Performs other duties and special projects as assigned.
Master’s prepared mental health clinician (LMSW, LCSW,LMHC), or licensed Registered Nurse (RN). New York State licensure required with previous mental health or substance abuse experience.
Minimum of 3 years of clinical mental health or substance abuse experience required.
UM or Case Management experience in a managed care organization is preferred.
Knowledgeable with diagnosis and procedural coding, Interqual and ASAM guidelines, psychiatric medication management, hospital case management, and related mental health and substance abuse treatment.
· Capable of independent thinking with excellent problem solving skills.
· Strong interpersonal, communication and computer skills with the ability to work in a
· Detail oriented with strong organizational skills including the ability to manage time wisely
to meet established deadlines.
· Ability to work in an energetic team environment.
· Experience with situations requiring strict adherence to confidentiality.
· Ability to solve problems while exhibiting clinical judgment and realistic understanding of the current environment.
· Ability to make independent decisions regarding resource utilization, and quality of care.
· Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with
emotionally charged situations
· Strong computer skills including working knowledge of Word, Windows based applications, typing and internet access
MVP Health Care is an Affirmative Action/Equal Opportunity Employer (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at firstname.lastname@example.org.
- Job Family Medical Management/Clinical
- Pay Type Salary
- Headquarters Office, Schenectady, New York, United States of America
- Rochester Office, Rochester, New York, United States of America
- Tarrytown Office, Tarrytown, New York, United States of America