Beacon Health Options CARE MANAGER in Latham, New York
Beacon Health Options
Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled.
Position Location: NY - Latham
AAP Reporting Location: NY - Latham
Job Family: Clinical, Licensed
Functional Area: CLINICAL OPERATIONS
FTE Status: Full time
Scheduled Weekly Work Hrs: 40
Workday Schedule: Weekdays Only
Workday Start Time: 8:30
Workday End Time: 5:00
Variable Work Schedule:
General Summary: Conducts telephonic assessments, collecting sufficient data to make appropriate referral and certification decisions. Collaborates and coordinates with providers and/or members of the treatment team to evaluate clinical appropriateness of treatment and interventions, and assist with the management of treatment across the continuum of care. Works to ensure treatment provided is timely, and designed to meet the member's individual needs. Works with providers and facilities to monitor and evaluate care at regular intervals to ensure progress towards goals. Uses ValueOptions' clinical policy and procedures to administer benefits as designed by the member's plan.
Essential Duties and Responsibilities:
- Reviews for medical appropriateness of psychiatric and substance abuse treatment utilizing ValueOptions' clinical criteria, policies and guidelines.
- Documents clinical data and certification decisions into the appropriate system, consistent with established guidelines and policies.
- Generates the appropriate correspondence within established timeframes.
- Provides appropriate referrals and assistance to members and providers in an effort to promote timely, quality care in the most appropriate treatment setting.
- Utilizes clinical rounds and case consultation with clinical supervisor, peer advisors and/or medical director for cases outside the criteria or those that are not progressing.
- Documents rounds consults as required in the system.
- Refers cases formally to the peer advisor when unable to render a certification decision using ValueOptions' clinical criteria and guidelines.
- Documents VSP cases as required per standards
- Assists facilities in transition and discharge planning. Ensuring appropriate discharge plans
- Assists with activities to promote continuous quality improvement in the department.
Education: A minimum of a B.S. Degree in mental health field or an Associate's Degree in Nursing with related psychiatric nursing experience.
Licensures: Current valid and unrestricted license in a state or territory of the United States in a mental health field (RN, Ph.D, LMSW/LCSW, MHC, LLP, LPC, etc.)
Relevant Work Experience: 3 - 5 years of direct practice experience in settings that include inpatient, partial, and/or outpatient preferred. For some roles CEAP or EAP internal/external consultant to a work site may be required. Strong customer orientation and excellent written and verbal communications skills required. Must possess strong computer skills.