Job Description

**Job Title:**
Care Manager - BH

**Address:**
San Diego, CA

**Schedule:**
Verify with a Recruiter or Staffing Manager!

**Job Description**
•Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
•Provides telephone triage, crisis intervention and emergency authorizations as assigned.
•Performs concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience.
•In conjunction with providers and facilities, develops discharge plans and oversees their implementation.
•Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.
•Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
•Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.
•Participates in quality improvement activities, including data collection, tracking, and analysis.
•Maintains an active workload in accordance with National Care Manager performance standards.
•Works with community agencies as appropriate.
•Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria.
•Participates in network development including identification and recruitment of quality providers as needed.
•Advocates for the patient to ensure treatment needs are met.
•Interacts with providers in a professional, respectful manner that facilitates the treatment process.

**Critical Information**
•Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements.
•One or more of the following licensures is required for this role with necessary degrees: CEAP, LMSW, LCSW, LPC, RN or LPN.
•Minimum 2 years of experience post-degree in healthcare, behavioral health, psychiatric and/or substance abuse healthcare setting.
•Strong organization, time management and communication skills.
•Knowledge of utilization management procedures, mental health and substance abuse community resources and providers.
•Knowledge and experience in inpatient and/or outpatient setting.
•Knowledge of DSM V or most current diagnostic edition.
•Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.

**Education/Licenses Needed**
•Dependent on CertificationAssociates: Nursing, Bachelors: Social Work, Masters: Social Work (Required)

**Benefits:**
•Benefits are available to full-time employees after 90 days of employment.
•A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.
•This is an AI-Formatted job description; therefore, this does not remove human decision-making.