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UM Care Manager - Retrospective Review in Little Rock, AR at Beacon Health Options

Date Posted: 1/11/2019

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic UM Care Manager to join our Retrospective Review team in Little Rock, AR!  The UM Care Manager evaluates submitted chart information and compares documentation to claims to evaluate compliance established rules and regulations for billed services.  Reports findings to Clinical team. Will also collect sufficient data to make appropriate authorization decisions.  As needed, collaborates and coordinates with providers, members and the treatment team to evaluate clinical appropriateness of treatment and interventions.  Works with providers to monitor and evaluate care at regular intervals to ensure progress towards goals. 

Position Responsibilities:

  • Responsible for clinical decisions related to members seeking access to their benefits for all levels of care using established criteria, guidelines and policies.  This includes referring cases that do not meet medical necessity criteria to a peer advisor when unable to render a certification decision.
  • Responsible for building positive professional rapport with providers and communicating in a clear and timely manner.
  • Utilizes rounds and case consultations with Clinical Manager and/or peer advisor for cases outside criteria.
  • Refers cases to Peer Advisor that does not meet criteria in line with established medical necessity rules.
  • Coordinates with providers, Care Coordinators and other Care Managers to assure that member treatment needs are met and that there is continuity of care.
  • Maintains confidentiality, ethical and professional standards, and adheres to established policies and procedures.
  • Maintains departmental productivity and performance standards.
  • Other duties as assigned.

Position Requirements:

  • Education: Master’s Degree or higher in a health related field or licensed RN
  • Licenses:  Current, valid, unrestricted clinical AR license (psychologist, LCSW, LPC or RN) required
  • Relevant Work Experience:  3 - 5 years’ experience in psychiatric and/or substance abuse treatment required
    • Experience in settings that include inpatient, partial, and/or outpatient treatment and care management services in a behavioral care management organization 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