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UM Care Manager

Company: Beacon Health Options
Location: Cypress
Posted on: October 13, 2020

Job Description:

About the Position:

Beacon Health Options is currently seeking a dynamicUM Care Manager to join our team in Cypress, CA! The UM Care Manager authorizes and reviews utilization of mental health and substance use services provided in inpatient and intermediate care settings; assists with discharge planning and ambulatory follow up activity, provides member assistance with mental health and substance use issues, and participates in special utilization projects.

Position Responsibilities:


  • Performs care review and authorization determinations for prospective, concurrent and discharge review with psychiatric and substance use treatment facilities as assigned
  • Determines appropriate level of care related to mental health and substance use treatment for members based on applicable medical necessity level of care criteria
  • Consults with Beacon Physician Advisors (PA) when requests for services do not appear to meet medical necessity criteria
  • Interacts with Physician Advisors to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases
  • Provides information to members and providers regarding mental health and substance use benefits and community treatment resources
  • Provides telephone triage and crisis intervention to callers and, when necessary, assists with ensuring members have access to local services and resources
  • Ensures notification of care determination is made to provider and member
  • Identifies and refers high risk members to care management
  • Recognizes quality of care issues and reports them appropriately through internal and external processes
  • Interacts with providers and facilities in a professional, respectful manner
  • Complies with all Beacon policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards
  • Participates in clinical rounds
  • Assists with NCQA, URAC and other QI initiatives
  • Other duties as assigned

    Position Requirements:

    • Education: B.S. Degree in mental health field or an A.A.S. Degree in Nursing with related psychiatric nursing experience required, M.S. Degree preferred
    • Licensure: Current, valid, unrestricted clinical license required (RN, LCSW, MFT, LPCC, PhD or PsyD) or BNS and must practice within the scope of license
    • Relevant Work Experience: 2 years post licensure experience of combined direct behavioral health clinical and managed care required

      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 (@BeaconHealthOptions.com). 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, Cypress , UM Care Manager, Executive , Cypress, California

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