Behavioral Health Utilization Care Manager

🔥 46 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $28 - $47 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Banner Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1999

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Banner Health is a leading healthcare system committed to making healthcare easier through comprehensive patient services and resources. They provide a safe place for care with services ranging from emergency and urgent care, imaging, and surgery centers to maternity and hospice care. Banner Health also offers telehealth options to ensure access to healthcare, regardless of location. They support athletes through Banner Orthopedics & Sports Medicine and have been recognized for exceptional patient care. With advanced digital tools, they aim to manage healthcare seamlessly for their patients.

📋 Description

• Authorize initial admissions and conduct concurrent reviews for medical necessity at assigned hospitals • Work with facilities and outpatient providers • Collaborate with other reviewers when patients’ continuum of care changes • Review and authorize behavioral health and substance abuse services in inpatient, residential, and outpatient settings using approved medical necessity criteria • Monitor care to ensure treatment is appropriate and effective • Assess members’ plans of care and develop, implement, monitor, and document utilization of resources and member progress • Provide telephonic or electronic document review • Engage internal and external resources to support appropriate care plans and discharge planning • Monitor for quality-of-care concerns • Staff regularly with medical directors • Provide education and recommend alternative care plans for treatment not meeting medical necessity criteria • Identify and resolve barriers to effective care delivery • Conduct prior authorization, concurrent, retrospective, and appeal reviews as needed • Manage individual members across the health care continuum • Lead process improvement activities for patient populations • Evaluate medical necessity and appropriateness of care • Establish collaborative relationships with physicians, payers, and health care team members • Collect and communicate information for utilization and regulatory requirements • Develop and manage interdisciplinary patient discharge plans • Educate internal health care team members on case management and managed care concepts

🎯 Requirements

• Requires master’s degree in social work, counseling or related field or with independent or associate licensure • Licensure in at least one of the following categories as required by state law: Social work, professional counseling or marriage and family • Appropriate licenses include: LCSW, LMSW, LPC, LAC, or Licensed Psychologist • Three years clinical experience, such as counseling, care management, case management, or care coordination in inpatient or outpatient levels of care • Working knowledge of care management, case management, hospital and community resources • Critical thinking skills, problem-solving abilities, effective communication skills, and time management skills • Ability to work effectively independently and in an interdisciplinary team format • Arizona residency required for compliance

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