Skip navigation
Unable to save this job. Please try again later.

{msg}

Email this Job to Yourself or a Friend

To begin the application process, please enter your email address.

Company Contact Info

Already have an account?

Sign in to apply with your saved resumes.

New to CareerBuilder?

Don't have an account? Continue as a guest!

Sorry, we cannot save or unsave this job right now.

Report this Job

Trust and Site Security Team.

Don't miss out on new jobs!

Get the latest Behavioral Health Care Manager jobs in US-Nationwide delivered directly to your inbox. You can unsubscribe at any time.

Saving Your Job Alert

Job Alert Saved!

Could not save Job Alert!

You have too many Job Alerts!

This email address has reached the maximum of 5 email alerts. To create a new alert, you will need to log into your email and unsubscribe from at least one.

Sign Up

or   Sign In Here
Password Must Contain
• 
8 to 15 characters
• 
1 uppercase letter
• 
1 number or symbol
• 
1 lowercase letter
Cancel
Create an Account with CareerBuilder to save jobs & unlock these great features
See similar job titles and skills to help you make your next move
Upload a resume and become visible to Hiring Managers and Employers
Compare Salary Information to see where you stand amongst your peers
Easily Quick Apply to jobs with just one click!

Email Send Failed!

UM Care Manager - West Region

Beacon Health Options • US-Nationwide

Posted 10 days ago

Job Snapshot

Full-Time
Degree - 4 Year Degree
Other Great Industries
Management

Job Description

About the Position:

We are currently seeking a dynamic UM Care Manager to join our team in Cypress, CA! The UM Care Manager is responsible for completing triage assessments to determine patient risk and appropriate level of care based on the medical necessity review as well as, performing ongoing utilization review, authorization for all higher levels (IP, RTC, PHP, IOP) of care (both psychiatric and substance use treatment.)

Position Responsibilities:

  • Responds to and completes urgent/emergent assessment and triage for members in accordance to Beacon/CHIPA/Regulatory standards and guidelines.
  • Logs on to phone queue and remains available to take calls from members, providers and facilities to answer any questions relating to utilization management.
  • Completes pre-certification and concurrent reviews for Inpatient, Residential Treatment and Diversionary services according to clinical criteria and CHIPA/regulatory guidelines.
  • Maintains a caseload of care cases for review (IP, RTC, PHP, IOP)
  • Schedules and complete chart reviews with a physician advisor when indicated.
  • Provides pertinent and relevant treatment and discharge plan recommendations to assist with member’s care
  • Requests copies of medical record when indicated
  • Coordinates care for members with other treatment team members including case management team when indicated
  • Schedules peer to peer review with a physician advisor according to guidelines and when indicated.
  • Participate in weekly clinical rounds with interdisciplinary team, physician advisor and/or clinical supervisor/manager.
  • Documents all authorizations and clinical notes in member file in the appropriate information system (IS)
  • Completes retrospective reviews as assigned by UM Supervisor or Manager.
  • Notifies Director of Utilization Management, Manager of Utilization Management and UM Supervisor of any quality indicators/concerns (PQI) including untoward event/incidents.
  • Adheres to all Beacon/CHIPA policies and procedures and standards of operations.
  • Completes all required and assigned trainings in a timely manner
  • Attend and participate in all mandatory company and department meetings.
  • Reports to each scheduled shift and performs essential job functions of a utilization management clinician.
  • Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  • Acts as a mentor to new team members by leading by example and guiding with a sense of integrity and team work.
  • Assist with training new hires on UM processes and workflows when assigned by UM Supervisor, Manager or Lead.
  • Assist with quarterly and new hire UM clinical review file audit when assigned by UM Manager, Supervisor or Lead.
  • Assists management in identifying opportunities for improvement, and training needs.
  • Assist team members and offers suggestions to improve processes, culture, or work environment.
  • Performs special projects and other duties as assigned and required.
  • Participates in quarterly Inter Rater Reliability
  • Has a good understanding to UM Guidelines, Level of Care Criteria, UM Policies and Procedures, and NCQA/ URAC standards.

Position Requirements:

  • Education: Bachelor’s Degree or equivalent in nursing or Master’s Degree in human services, psychology or related field required
  • Licensures: Current, unrestricted, valid state clinical license (LPT, LVN, RN, LCSW, MFT, PhD) required
  • Relevant Work Experience: 5 years of direct patient services preferably in a behavioral health setting required
  • Knowledge, Skills, & Abilities:
    • Knowledge of medical necessity criteria and treatment protocols for psychiatric and chemical dependency diagnoses 
    • Excellent prioritization and organization skills
    • Strong interpersonal skills and good written and verbal communication skills
    • Advanced level of PC skills required

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

PM16

#CB

#GD

$REM

Job ID: 56062
Help us improve CareerBuilder by providing feedback about this job: Report this Job.
CAREERBUILDER TIP
For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.
By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.
Don't miss out on new jobs like this
Get the latest jobs delivered to your inbox. Unsubscribe at any time.

Saving Your Job Alert

Job Alert Created

Well, this is embarrassing. We are having trouble saving your search. You can try again or come back at a later time.

Maximum Email Alerts

This email address has reached the maximum of 5 email alerts. To create a new alert, you will need to log into your email and unsubscribe from at least one.

More Jobs at Beacon Health Options

View All Similar Jobs View All Similar Jobs