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UM Care Manager

Company: Beacon Health Options
Location: New York
Posted on: August 17, 2019

Job Description:

Beacon Health OptionsJob Category: Clinical - Care MgmtReq #: CAREM01355Schedule: Full TimeLocation: NY - ManhattanAbout the Position:

Beacon Health Options is currently seeking a dynamic UM Care Manager to join our NY Children's team remotely*! The UM Care Manager authorizes and reviews utilization of mental health and substance use services provided in inpatient and intermediate care settings; assists with discharge planning and ambulatory follow up activity, provides member assistance with mental health and substance use issues, and participates in special utilization projects. The UM Care Manager will primarily be focused on members under 21 years of age within NY State and will utilize children's specific knowledge and expertise in assessing the behavioral health needs unique to children. The UM Care Manager will assist in coordinating care with children's specialty services.

*This position will be a combination of office work, work from home, and field based (schools, hospitals, clinics, homes)*



Position Responsibilities:

  • Demonstrated experience establishing relationships and effectively engaging with members and providers through telephonic communication to obtain necessary information and facilitate care in multiple settings.
  • Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes.
  • Demonstrated work experience in meeting strict deadlines and established cycle times through effective prioritization and follow-up skills.
  • Clinicians are required to be educated in current principles, procedures of behavior health care. Managed care and state specific expertise and knowledge of community resources experience preferred.
  • Performs telephonic care review and authorization determinations for prospective, concurrent and discharge review with psychiatric and substance use treatment facilities as assigned
  • Determines appropriate level of care related to mental health and substance use treatment for members based on Beacon medical necessity level of care criteria
  • Consults with Beacon Physician Advisors (PA) when requests for services do not meet medical necessity criteria
  • Interacts with Physician Advisors to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases
  • Provides information to members and providers regarding mental health and substance use benefits and community treatment resources
  • Provides telephone triage and crisis intervention to callers and, when necessary, assists with ensuring members have access to local services and resources
  • Ensures notification of care determination is made to provider and member
  • Identifies and refers high risk members to care management.
  • Recognizes quality of care issues and reports them appropriately through internal and external processes.
  • Interacts with providers and facilities in a professional, respectful manner
  • Complies with all Beacon policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards.
  • Demonstrates thorough understanding of product lines and benefit structure for all contracts assigned
  • Participates in clinical rounds
  • Assists with NCQA, URAC and other QI initiatives
  • Other duties as assigned


    Position Requirements:
    • Education: Master's degree or higher in a health related field and licensure as a behavioral health professional or RN required
    • Licensures: Current, valid, unrestricted clinical license required (RN, LCSW, MFT, LPCC, PhD or PsyD) or BNS required and must practice within the scope of license
    • Relevant Work Experience: 3 years of experience treating children in a behavioral health setting required
    • Knowledge, Skills, & Abilities:
      • Experience in managing care for children and the target subpopulations including high-risk groups, such as children with SED, with co-occurring major mental disorders and SUD, who are involved in multiple services systems, or in foster care
      • Knowledge and experience in Children's health and BH services, HCBS, EBPs, EPSDT services and social service programs


        To Apply:

        Click below on "Apply for this Position" to create a profile and apply for the position



        Beacon Health Options 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



        At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.



        #CB

        #GD

        PM16 PI112718980

Keywords: Beacon Health Options, New York , UM Care Manager, Executive , New York, New York

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