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UM Care Manager - West Region
Beacon Health Options • US-Nationwide
Posted 27 days ago
About the Position:
We are currently seeking a dynamic UM Care Manager to join our Utilization Management team in Cypress, CA or remotely! The Care Manager is a position in fast-paced environment that serves the members population seeking behavioral health services. The Care Manager is responsible for screening and triaging members to appropriate level of care and providing resources and referrals.
*This can be a remote / work at home job opportunity for applicants residing and licensed in the state of California*
*This position requires a rotating late shift from 11:30am - 8:00pm around 3 days per month*
- Responds to screening and triaging members telephonically to determine appropriate level of care
- Utilization Review with providers based on claims trigger data and 6 month reviews
- Work collaboratively to coordinate a supportive environment and clear communication;
- Maintaining accurate information in Beacon’s clinical documentation systems as directed
- Telephonic collaboration with provider and county agencies regarding members in treatment
- Participation in systems meetings as needed
- Collaborate with Primary Care Physician (PCP), Behavioral Health Professionals (BHP), and other members of the health care team, including health plan medical care managers and others to arrange and coordinate services for the member and optimize the member’s ability to engage in the appropriate plan of care;
- Assist with NCQA and URAC initiatives
- Respond to urgent calls
- Telephonic collaboration with Members
- Treatment Record Reviews
- Attend Clinical meetings
- Adheres to all Beacon policies and procedures and standards of operations.
- Completes all required and assigned trainings.
- Attends all mandatory company or department meetings.
- Reports to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.
- Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
- Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work.
- Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.
- Assist team members and offers suggestions to improve processes, culture, or work environment.
- Performs special projects and other duties as assigned and required.
- Education: Bachelor of Science in Nursing (BSN) or Master’s Degree in mental health related discipline required
- Licensures: Current, valid, unrestricted licensed behavioral health clinician or nurse (LCSW, LMFT, LPCC, RN, Ph.D. or PsyD.) required
- Relevant Work Experience: 3 years behavioral health clinical practice required
Knowledge, Skills, & Abilities:
- Educated in current principles and procedures of behavior health care.
- Knowledge of managed care and state specific expertise preferred.
- Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes.
- Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up.
- Strong interpersonal skills and good written and verbal communication skills.
- Advanced computer skills required, including working knowledge of MS Office: Word, Excel, and PowerPoint.
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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.