Behavioral Health Case Manager

Innova Solutions Inc; Philadelphia (Philadelphia County); Remote; USD 55,000 - 62,000; Full time

Job summary

Innova Solutions is seeking a Behavioral Health Utilization Management professional for a full-time contract position in Philadelphia, PA (Remote). The role requires clinical Behavioral Health experience in a hospital or health system and licensure in PA (LCSW/LMFT/LPC or RN).

You will review care plans, determine medical necessity, and coordinate with providers to ensure appropriate levels of care. Responsibilities include supporting discharge planning, data entry, and ensuring compliance with

Qualifications

• Minimum of three (3) years of Behavioral Health clinical experience in a hospital or other health care setting.
• LCSW or LMFT or LPC or Active PA Licensed RN

Responsibilities

• Apply critical thinking and judgement based on medical knowledge to determine case suitability.
• Use InterQual, Medical Policy and related references to assess medical necessity.
• Determine inpatient vs. outpatient needs and level of care.
• Communicate with providers to clarify plan of care and services.
• Refer complex cases to Medical Director for further evaluation.
• Ensure regulatory compliance and timely documentation of actions.

Skills

Behavioral Health experience

PA license or equivalent

Education

BSN

Job description

Job Overview

Position type: Full Time - Contract Duration: 03 Months
Location: Philadelphia, PA (Remote)

Responsibilities

• Apply critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determination.
• Utilizes resources such as; InterQual, Care Management Policy, Medical Policy and Electronic Desk References to determine the medical appropriateness of the proposed plan.
• Utilizes the medical criteria of InterQual and/or Medical Policy to establish the need for inpatient, continued stay and length of stay, procedures and ancillary services.
• servicing providers regarding treatment plans/plan of care and clarifies medical need for services.
• Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or continued stay, clarifying medical information with provider if needed.
• Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination.
• Performs early identification of members to evaluate discharge planning needs.
• Collaborates with case management staff or physicians to determine alternative settings at times and provide support to facilitate discharge to the most appropriate setting.
• Reports on potential utilization issues or trends to designated managers and recommendations for improvement.
• Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care.
• Appropriately refers to Case and Disease Management.
• Ensures request is covered within the member's benefit plan.
• Ensures utilization decisions are compliant with state, federal and accreditation regulations.
• Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.
• Ensures that all key functions are documented via Care Management and Coordination Policy.
• Maintains the integrity of the system information by timely, accurate data entry.
• Performs additional duties assigned.

Ideal Candidate

• Minimum of three (3) years of Behavioral Health clinical experience in a hospital or other health care setting.
• LCSW or LMFT or LPC or Active PA Licensed RN

Preferred Qualifications

• BSN
• Prior Behavioral Health utilization management experience.
• Medical management/precertification experience.

This position is only open to applicants who can be engaged on a W-2 basis.

If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines.

Pay Range

Pay Range*: $40 - $45 per hour

*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.

Benefits

• Medical & pharmacy coverage
• Dental/vision insurance
• 401(k)
• Health saving account (HSA) and Flexible spending account (FSA)
• Life Insurance
• Pet Insurance
• Short term and Long term Disability
• Accident & Critical illness coverage
• Pre-paid legal & ID theft protection
• Sick time, and other types of paid leaves (as required by law)
• Employee Assistance Program (EAP)

About Innova Solutions

Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions

• Named One of America's Best Employers for New Grads by Forbes (2024
• Named One of the Best Companies to Work for by U.S. News & World Report (Private Companies List, 2024-2025)
• One of the Largest IT Staffing Firms in the US - Ranked #3 by Staffing Industry Analysts (SIA, 2024)
• One of the Largest Staffing Firms in the US - Ranked #13 by Staffing Industry Analysts (SIA, 2024; includes Innova Solutions, Volt, & HireGenics)
• Named One of the Top Ten Private Companies in Atlanta by the Atlanta Business Chronicle (2023)
• One of the Largest Certified Minority Business Enterprises (MBEs) in the United States (NMSDC, 2024)
• AWS Advanced Tier Services Partner with 100+ certifications

Website: https://www.innovasolutions.com/

Innova Solutions offers a referral bonus for qualified Ambassadors who refer eligible referrals.

Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment.

Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates.

If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at [emailprotected] or [phone].

Please indicate the specifics of the assistance needed.

Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.

The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.