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Licensed Clinical Case Manager/URC

Licensed Clinical Case Manager/URC

Job Description

Reviewsoutpatient [OP] behavioral health service requests based on specific level ofcare and medical necessity criteria; provides member assistance with registeringfor and accessing services from provider network or other available behavioralhealth resources as needed.

Job Requirements

  1. Determines appropriateness of OP behavioral health services for members based on medical necessity criteria as prescribed by the Orange County Mental Health Plan and CalOptima.
  2. Interacts with physicians and other members of the provider clinical team for authorization decisions
  3. Performs telephonic assessments and case review as needed
  4. Provides information to members and providers regarding their behavioral health benefits, and community treatment resources
  5. Interacts with the Clinical Team Lead to discuss clinical questions and concerns regarding specific cases
  6. Interacts with providers and facilities in a professional, respectful manner that facilitates access to the treatment process
  7. Determines medical necessity for behavioral health problems according to clinical information given by members, providers and internal criteria for medical necessity and appropriateness of care
  8. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria
  9. Complies with Beacon’s standards for documentation of clinical information, clinical contacts and authorization of care
  10. Manages requests from members and providers for In and Out of Network services
  11. Attends departmental and other meetings as necessary
  12. Other duties as assigned, including telephone triage, crisis intervention and emergency services as required 


Qualifications:

Current,valid and unrestricted licensure for practice required with proof on date ofhire (LCSW, LMFT, LPCC, RN, PhD. or PsyD). Re-verification will take place no less than every 2 years.

    1. Good organization, time management and communications skills
    2. Excellent computer skills
    3. Knowledge of utilization management procedures, behavioral health community resources and providers
    4. Ability to function independently and as a team member
    5. Knowledge of DSM IV-TR or most current diagnostic edition 

    Job Snapshot

    Employment Type Full-Time
    Job Type Health Care
    Education Graduate Degree
    Experience Not Specified
    Manages Others Not Specified
    Industry Healthcare - Health Services
    Required Travel Not Specified
    Job ID ZZZ-04
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    Licensed Clinical Case Manager/URC


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