Care Manager II, UM
Location: Jacksonville Florida
Description: New Directions Behavioral Health is currently seeking to employ Care Manager II, UM right now, this occupation will be placed in Florida. More details about this occupation opportunity kindly see the descriptions. Utilization Management
New Directions Behavioral Health, founded in 1995, is dedicated to helping people find a healthy balance and improve health through positive change. We ! offer managed behavioral healthcare, employee assistance, organizational consulting, and health coaching programs.
As behavior change experts, we provide a full range of proven practices to help individuals attain healthier and more balanced lifestyles. In fact, we serve the behavioral health needs of millions of people in Kansas, Missouri, Arkansas, and across the nation.
New Directions is the fastest growing behavioral health care company. Our services have earned national recognition and awards for innovation and best practices. And we are accredited by NCQA as an MBHO and by URAC for utilization management and case management.
New Directions is seeking a Care Manager II (UM) to be responsible for the daily behavioral health clinical care coordination for New Directions members. This includes the activities of continued stay review, discharge planning, utilization review, patient education, benefits management, and provider education regarding ! company policies and procedures. All activities are completed ! from a customer service perspective. Care Managers assist in the exception, denial and appeal process; the adjudication of claims in which New Directions is involved; development and implementation of new programs, and the monitoring and participation of processes required for compliance with external accrediting agencies. Work is closely coordinated with Intake Coordinators, Resource Coordination, Network Operations, Physician Peers, providers, claims examiners, management and other staff within New Directions as well as all constituents within the behavioral health system to assure efficient and effective management of all members and their needs.
The Care Manager, UM’s Key Responsibilities include:
Provides utilization review activities for all levels of behavioral health care, including inpatient, residential, partial hospitalization intensive outpatient and outpatient authorization requests with contacts to facilities and providers as needed to ac! complish this task.
Demonstrates clinical expertise in response to a variety of circumstances ranging from crisis intervention to routine business matters.
Participates in clinical staffing.
Presents clinical cases to staff and consulting providers upon request of supervisor.
Completes appropriate documentation in clinical systems in compliance with regulatory and accreditation standards.
Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and New Directions services, policies and procedures and criteria.
Coordinates peer review with NDBH Physician consultants on clinical cases that are not meeting the medical necessity criteria.
Complies with all Federal and applicable State laws and New Directions Behavioral Health Policies regarding, privacy, confidentiality, and security of health information, ! and other designated information.
Completes Critical Intervent! ion Plans as needed.
Coordinates discharge planning, including ensuring follow up appointments for member’s post discharge from inpatient care within 7 days.
Provides follow-up and support calls to members and providers as needed and as assigned by Manager/Supervisor
Participates in on-going continuing education as required by professional licensure, certification, or as requested by New Directions.
Participates in special committees or projects for program development as assigned by Manager/Supervisor.
Assumes other duties consistent with position and as directed by Manager/Supervisor.
Required Qualifications:
Qualified candidates will have a current, unrestricted FL license to practice independently as a Clinical Social Worker, Marriage and Family Therapist, Professional Counselor, Clinical Psychologist or RN. For RN’s a Bachelor’s degree in Nursing is required.
A minimum of 2 years post licen! sure experience in direct clinical care with patients in facility-based and/or outpatient psychiatric or chemical dependency treatment is required.
Strong computer skills (Word and Excel) required.
Ability to comprehend medical policy and criteria to clearly articulate health information is required.
Excellent communication and interpersonal skills are essential.
Self motivation and the ability to assume a lead role in ensuring that all objectives are met is desired.
Preferred Qualifications:
Previous experience in Utilization Review is preferred.
New Directions Behavioral Health is an Equal Opportunity Employer M/D/V/F.
We offer a very competitive compensation and benefits package.
For consideration, please apply on-line at www.ndbh.com.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to New Directions Behavioral H! ealth.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Tue, 16 Oct 2012 07:02:08 GMT