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Clinical Care Manager II

Company: Beacon Health Options
Location: Wixom
Posted on: September 17, 2020

Job Description:

Beacon Health OptionsJob Category: Clinical - Care MgmtReq #: CLINI02927Schedule: Part TimeLocation: MI - Wixom

We are currently seeking aClinicalCare Manager IIto join our Central Referral Lineteam in Wixom, MI! The Care Manager will provide telephonic assessments, referrals and brief clinical interventions to make appropriate referral and certification decisions for routine and emergent/urgent referrals requiring for all levels of care.

MUST RESIDE IN MI & HOLD ACTIVE MI STATEMENTAL/BEHAVIORAL HEALTH LICENSE

This position provides assessments, referrals and counseling. Conducts telephone assessments, collecting sufficient clinical information to make appropriate referral and certification decision for emergency/urgent referrals that require alternate levels of care. Makes appropriate certification decisions. Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible. Facilitates coordination of care with other managers to assure continuity of care. Evaluates clinical appropriateness of treatment using professional knowledge within Beacon Health Options clinical and work site guidelines. Will render certification decisions, or seeks consultations for non-certification decisions. Will facilitate all tracking necessary quality indicators to meet these necessary accrediting bodies (NCQA, URAC). Directs members to an appropriate therapist or EAP provider. Clinical Care Manager refers cases to MD, or management on a regular basis to determine whether treatment meets Beacon Health Options criteria for medical necessity. Establishes and delivers knowledge about care resources and levels of care availability. Special projects and all other duties as assigned.

What does a typical day look like?

Triage Assessment and Referral

Complete telephone assessments and referral; gathers demographic and clinical information to connect patient with appropriate provider, including outpatient treatment as necessary; and for emergency, urgent, routine and EAP referrals. Provide appropriate referrals for treatment based in assessment of information gathered during telephone contacts and or on-site with providers. Refer cases that do not meet criteria and need non-cert., to Peer Advisors. Manage release of MHSA benefit provided by carrier for designated group. Ask questions and listen to member in order to assess case and determine needs. Give referral and/or make referral appointment as circumstances warrant.

Clinical Reviews

Review for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply Beacon Health Options criteria and render certification decisions that are within the scope of practice that is relevant to the clinical area under review. Provide reviews for predetermination of medical necessity. Review proposed courses of treatment for medical necessity. Utilize rounds and case consultations to Clinical Supervisor and Peer Advisor for cases outside criteria or not progressing.

Customer Service

Interface with internal and external customers to maintain optimal efficiency of service. Maintain telephone superior service standards. Contribute to monthly staff meetings and clinical conferences. Attend appropriate meetings, trainings and conference calls as scheduled. Perform all other aspects of customer service as required. Conduct business in a professional manner. Troubleshoot Clinical issues. Investigate and research to resolve customer complaint problems and issues.

What you Contribute?

Education: Masters' degree in social work or psychology or a Bachelor's level RN.

Licensure:Must have a current, valid and unrestricted MI state license in a mental health field (RN, Ph.D., LCSW/ACSW/LMSW, LLP, MHC, LPC, etc.). May be required to obtain additional state licensures dependent on client contractual requirements

Relevant Work Experience: A minimum of 3 years' experience in psychiatric or substance use treatment. Experience in settings that include inpatient, partial, and/or outpatient care preferred. Experience as a CEAP or EAP internal/external consultant to a work site area required (for the integrated unit.

What Makes Us Different?

  • Here, it's not just a job - it's an opportunity to change lives.
  • Our employees are learners, innovators and original
  • Our mission and values guide the way we treat our members, providers and each other.
    What We Have to Offer:
    • Healthcare benefits available starting day 1!
    • Health & well-being incentives, such as gym membership reimbursement
    • 401K with company match to help reach your future financial goals
    • Generous PTO, because we know life happens outside of work
    • Tuition reimbursement so you can keep reaching your fullest potential
      If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!

      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

      At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

      #GD

      PM16

Keywords: Beacon Health Options, Detroit , Clinical Care Manager II, Executive , Wixom, Michigan

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