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CARE MANAGER-UTILIZATION MGMT in Grand Rapids, MI at Beacon Health Options

Date Posted: 11/19/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a team of dynamic Utilization Review Care Managers to join our team at our office in Grand Rapids, MI.  The UR Care Managers will be responsible for performing authorization determinations of mental health and substance use services provided in inpatient, outpatient and/or diversionary care settings. 

Position Responsibilities:

  • Determines appropriate level of care related to mental health and substance use treatment for members based on the applicable medical necessity level of care criteria (Beacon proprietary, CMS, ASAM, State specific or other required criteria) and ensures that all Beacon’s policy and procedure guidelines, external regulatory requirements and URAC/NCQA accreditation standards are met.
  • Interacts (and educates) with Community Mental Health Service Programs (CMHSP) agency staff to ensure medical necessity criteria is being reviewed and applied appropriately
  • Consults with Beacon’s 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
  • Consults with Beacon’s Physician Advisors (PA) when requests for services do not meet medical necessity criteria

Position Requirements:

Education: Master’s degree or higher in a health related field required or RN licensure with equivalent psych experience.

Licensure:  Current, valid, and unrestricted licensed behavioral health clinician and practice within the scope of their licensure with a minimum of 2 years behavioral health experience.

Relevant Work Experience:   A minimum of 2 years behavioral health experience

Knowledge, Skills & Abilities:

  • Required to be educated in current principles, procedures and knowledge of behavior health. 
  • Keen attention to detail
  • Able to multitask with ease
  • Moderate skill level in Microsoft applications (Outlook, Word, Excel, PowerPoint)
  • Good written and verbal communication skills
  • Desire to continually improve problem resolution skills
  • Team player with an ability to work under pressure
  • Ability to remain objective in all dealings with customers and maintain professional attitude
  • Ability to prioritize tasks and accomplish them in a timely fashion
  • Excellent provider/customer relations skills

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

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