PR: $39/hr - $40/hr

About the Role

• This position involves monitoring inpatient and outpatient services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
• The role includes providing telephone triage, crisis intervention, and emergency authorizations, as well as performing concurrent reviews for various levels of care.
• The successful candidate will collaborate with providers and facilities to develop and oversee discharge plans, perform quality clinical reviews, and educate members and providers on mental health and substance abuse benefits.

Responsibilities

• Conduct concurrent reviews for inpatient and outpatient care.
• Develop and oversee discharge plans in collaboration with providers and facilities.
• Provide telephone triage, crisis intervention, and emergency authorizations.
• Educate members and providers on mental health and substance abuse benefits and resources.
• Interact with Physician Advisors to discuss clinical and authorization questions.
• Participate in quality improvement activities, including data collection and analysis.
• Maintain an active workload in accordance with performance standards.
• Work with community agencies and propose alternative treatment plans when necessary.
• Participate in network development and advocate for patient treatment needs.
• Interact professionally with providers to facilitate the treatment process.

Education Qualification

• Dependent on Certification: Associates in Nursing, Bachelors in Social Work, or Masters in Social Work (Required).

Required Skills

• Current licensure that meets state or customer specific requirements (CEAP, LMSW, LCSW, LPC, RN, or LPN).
• Minimum of 2 years of experience in healthcare, behavioral health, psychiatric, and/or substance abuse settings.
• Strong organizational, time management, and communication skills.
• Knowledge of utilization management procedures and community resources.
• Experience in inpatient and/or outpatient settings.
• Familiarity with DSM V or the most current diagnostic edition.
• Ability to analyze utilization problems and implement solutions to improve quality of care.