Care Manager Behavioral Health

Highmark; Meadville (Crawford County); On-site; USD 50,200 - 91,200; Full time

Job summary

A healthcare organization seeks a Care Manager Behavioral Health to implement effective utilization management strategies. The role includes monitoring healthcare service delivery, educating providers and members, and analyzing data to improve outcomes. Candidates should have a High School Diploma/GED with RN license or a Master's degree if a licensed behavioral health professional, as well as 3–5 years of relevant experience. Excellent communication skills and knowledge of regulatory guidelines are essential. Salary ranges from $50,200 to $91,200, depending on experience.

Qualifications

• 3–5 years of post licensure experience in Behavioral Health Clinical and/or Case Management.
• Experience in a clinical setting.
• Certification in utilization management or a related field is preferred.

Responsibilities

• Implement care management review processes according to criteria and guidelines.
• Educate providers and members, streamlining processes.
• Utilize outcomes data to improve ongoing care management services.

Skills

Working knowledge of pertinent regulatory and compliance guidelines and medical policies

Ability to multi task and perform in a fast paced and often intense environment

Excellent written and verbal communication skills

Ability to analyze data, measure outcomes, and develop action plans

Be enthusiastic, innovative, and flexible

Be a team player who possesses strong analytical and organizational skills

Demonstrated ability to prioritize work demands and meet deadlines

Excellent computer and software knowledge and skills

Education

High School Diploma/GED with RN license or Master's Degree if licensed behavioral health professional

Bachelor’s degree in Nursing

Job description

Care Manager Behavioral Health – Highmark

Job Summary

This job implements the effective utilization management strategies including review of appropriateness of health care services, application of criteria to assure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives.

Essential Responsibilities

• Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline. Effectively function in accordance with applicable state, federal laws and regulatory compliance.
• Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies. Promote quality and efficiency in the delivery of care management services.
• Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws. Practice within the scope of ethical principles.
• Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions. Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member.
• Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships. Develop and sustain positive working relationships with internal and external customers.
• Utilize outcomes data to improve ongoing care management services.
• Other duties as assigned or requested.

Education

• High School Diploma/GED with RN license or Master's Degree if licensed behavioral health professional

Substitutions

• None

Preferred Education

• Bachelor’s degree in Nursing

Experience

Required

• 3–5 years of post licensure experience in a combination of Behavioral Health Clinical, Case Management and/or Condition Management
• Experience in a clinical setting

Preferred

• Certification in utilization management or a related field
• Experience in UM/CM/QA/Managed Care

Licenses and Certifications

Required

• Licensed Social Worker (LSW)
• Licensed Clinical Social Worker (LCSW)
• Licensed Professional Counselor (LPC)
• Licensed Marriage and Family Therapist (LMFT)
• Licensed Behavior Specialist
• Registered Nurse

Preferred

• None

Skills

• Working knowledge of pertinent regulatory and compliance guidelines and medical policies
• Ability to multi task and perform in a fast paced and often intense environment
• Excellent written and verbal communication skills
• Ability to analyze data, measure outcomes, and develop action plans
• Be enthusiastic, innovative, and flexible
• Be a team player who possesses strong analytical and organizational skills
• Demonstrated ability to prioritize work demands and meet deadlines
• Excellent computer and software knowledge and skills

Travel Requirement

0% – 25%

Physical, Mental Demands and Working Conditions

• Office-based
• Teaches / trains others regularly
• Occasionally travel regularly from the office to various work sites or from site-to-site
• Works primarily out-of-the office selling products/services (sales employees)
• Never has physical work site required
• Lifting up to 10 pounds
• Constantly lifting 10 to 25 pounds
• Occasionally lifting 25 to 50 pounds
• Rarely lifting 25 to 50 pounds

Disclaimer

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct, including adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range

$50,200 – $91,200

EEO Statement

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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