UM Care Manager - Retrospective Review in Latham, NY at Beacon Health Options

Date Posted: 3/27/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic UM Retrospective Review Clinician to join our growing Utilization Management team in Latham, NY! The UM Retrospective Review Clinician is responsible for performing retrospective review and appeal authorization determinations for mental health and substance use services provided in inpatient, diversionary and outpatient care settings.  She/he applies Beacon’s medical necessity criteria (MNC) and ensures that all Beacon policy and procedure guidelines, compliance, external regulatory requirements and URAC/NCQA accreditation standards are met.

Position Responsibilities:

  • Authorize and review the utilization of mental health and substance use services provided in inpatient and intermediate care settings for retrospective reviews (i.e., in cases where a request for authorization is submitted after patient admission) and appeal requests.  Apply medical necessity criteria in all authorization of psychiatric and substance use services.
  • Collaborate with other UM Clinicians, Physician Reviewers, and Clinical Supervisors to produce high-quality and efficient determinations
  • Appropriately consult and escalate cases to clinical supervisors and/or Physician reviewers as appropriate; follow standard operating procedures to prep medical charts for cases to be escalated to physician, which includes reviewing and organizing medical charts, and highlighting and bookmarking pertinent text to aid physician in medical chart reviews and determining medical necessity, etc.
  • Accurately document authorization reviews in the company system according to company guidelines while maintaining productivity, quality and other standards
  • Provide optimum customer service through professional/accurate communication
  • Required to maintain all NCQA, URAC, state and health plan/client required standards
  • Identify and refer high risk members to care management.
  • Collaborate with Care Management, Intake and Discharge teams as needed.
  • Recognize quality of care issues and report appropriately through internal and external processes.
  • Demonstrates work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up skills
  • Comply with all Beacon policies and procedures
  • Participate in scheduled staff meetings and trainings
  • Participates in rounds and case conference as required
  • Strong communication and interpersonal skills
  • Ability to handle multiple, competing priorities
  • Ability to type and transcribe information in a fast-paced environment

Position Requirements:

  • Education: Master’s Degree or higher in a health related field and independent licensure as a behavioral health professional required, or BSN and independent licensure as a behavioral health professional required
  • Licensures: Current, valid, unrestricted clinical license required (RN, LCSW, MFT, LPCC, PhD or PsyD) and must practice within the scope of license with a minimum of 2 years behavioral health experience providing behavioral health assessments and treatment
  • Relevant Work Experience: 5 years combined direct behavioral health, supervisory and/or managed care experience required
  • Knowledge, Skills, & Abilities: 
    • Knowledge of current principles and procedures of behavior health care, requiring full knowledge and application of ASAM, MNC criteria and evidenced-based treatment approaches
    • Managed care and state, client and regulatory specific expertise and knowledge of community resources experience preferred

To Apply:

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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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