Description
Primary City/State:
Arizona, ArizonaDepartment Name:
Behavioral HealthWork Shift:
DayJob Category:
Clinical CareYou have a place in the health care industry. If you're looking to leverage your abilities to make a real difference – and real change in the health care industry – you belong at Banner Plans & Networks.
Recognized nationally as an innovative leader in health care, Banner Plans & Networks (BPN) integrates Medicare and private health plans to reduce healthcare costs while keeping our members in optimal health. Known for our innovative, collaborative, and team-oriented approach, BPN offers a variety of career opportunities and innovative employment options by offering remote and hybrid work settings.
As a Behavioral Health Utilization Care Manager, you will be assigned to various hospitals where you will authorize initial admitting and do concurrent reviews for medical necessity. You will be working with hospitals and out-patient providers. You will utilize your clinical experience, excellent collaboration skills, and ability to be a strong communicator to meet requirements for compliancy and member care.
Your work schedule will be Monday-Friday primarily 8:00 a.m.- 5:00 p.m. Arizona Time Zone. Your work location will be entirely remote. This position does require Arizona residency for compliance. This is a salaried role. If this role sounds like the one for you, apply today!
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.POSITION SUMMARY
This position is the point person for all utilization activities for assigned members. As part of an interdisciplinary team, this position reviews and authorizes behavioral health and substance abuse services in inpatient, residential and outpatient settings using approved medical necessity criteria. Monitors care to ensure treatment is appropriate and effective. This position assesses the member's plan of care and develops, implements, monitors and documents the utilization of resources and progress of the member through their care, facilitating options and services to meet the member's health care needs. This position provides telephonic or electronic document review. This position engages internal and external resources to ensure members receive appropriate care plan and discharge planning services. This position monitors for quality of care concerns. Will staff regularly with medical directors. Within the scope of their position and licensure, this position will provide education and recommend alternative care plans for treatment not meeting medical necessity criteria. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective care delivery to members. May conduct prior authorization, concurrent, retrospective, and appeal reviews.
CORE FUNCTIONS
1. Manages individual members across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
2. Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
3. Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes.
4. Establishes and promotes a collaborative relationship with physicians, other payers, and other members of the health care team. Collects and communicates pertinent, timely information to fulfill utilization and regulatory requirements.
5. Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care.
6. Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice.
7. Has the freedom to determine how to best accomplish functions within established procedures. Confers with supervisor on any unusual situations. Positions are facility based with potential for remote work, with no budgetary responsibility. Internal customers: All levels of health plan staff, medical staff, and all other members of the interdisciplinary health care team. External Customers: Hospitals, physicians and their office staff, payers, community agencies, provider networks, and regulatory agencies.
MINIMUM QUALIFICATIONS
Requires master's degree in social work, counseling or related field or with independent or associate licensure. Licensure in at least one of the following categories as required by state law: Social work, professional counseling or marriage and family. Appropriate licenses include: LCSW, LMSW, LPC, LAC, or Licensed Psychologist. Requires a proficiency level typically achieved with three years clinical experience (i.e. counseling, care management, case management, care coordination in inpatient or outpatient levels of care).
Must have a working knowledge of care management, case management, hospital and community resources. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively independently and in an interdisciplinary team format.
PREFERRED QUALIFICATIONS
Previous experience with behavioral health utilization management.
Additional related education and/or experience preferred.
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