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Care Manager
2 meses atrás
About the Role:
Integrated Resources, Inc. is seeking a highly skilled Care Manager to join our team. As a Care Manager, you will play a critical role in ensuring the delivery of high-quality, patient-centered care to our members.
Key Responsibilities:
- Authorize and collect and analyze utilization data to ensure medical necessity and effectiveness of inpatient and intermediate level of care services related to mental health and substance abuse treatment.
- Assist with discharge planning and ambulatory follow-up activity to ensure a smooth transition of care for our members.
- Provide member assistance with mental health and substance abuse issues, and participate in special quality improvement projects to drive continuous improvement in our services.
- Monitor inpatient and intermediate level of care services to ensure compliance with medical necessity and effectiveness standards.
- Provide telephone triage, crisis intervention, and emergency authorizations as assigned to ensure timely and effective support for our members.
- Develop and implement discharge plans in conjunction with providers and facilities to ensure a seamless transition of care.
- Perform concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience to ensure medical necessity and effectiveness.
- Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures.
- Interact with Physician Advisors to discuss clinical/authorization questions and concerns regarding specific cases.
Requirements:
- Department hours: 8am – 6pm. The selected candidate will work from 8:30am – 5pm.
- License: LCPC, LCSW, LSW or RN.
- Caseload: 20 calls/day.
- Experience: At least 1 year of Managed Care experience AND Drug & Alcohol experience.
- Community Resource Experience: Required.
- Candidate must be comfortable working in a cubicle environment, typing and talking simultaneously, in a fast-paced environment, and navigating through multiple systems.
- MUST be computer literate.
