Location: Atlanta, GA/Albany, NY. This is an office-based position. Shift: Between the hours of 8:00am and 6:00pm, Monday-Friday
Responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review. Primary duties may include, but are not limited to:
- Uses appropriate screening criteria, knowledge and clinical judgment to assess member needs to ensure access to medically necessary, quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract.
- Refers cases to Peer Reviewers as appropriate.
- Performs psychiatric and substance abuse or substance abuse disorder assessment, coordination, implementation, case planning, monitoring, and evaluating to promote quality member outcomes, to optimize member health benefits, and to promote effective use of health benefits and community resources.
- Requires MS or MA in social work, counseling, nursing or a related behavioral health field; 3 years experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience, which would provide an equivalent background.
- Current unrestricted license from the applicable states (GA or NY) as an LMHC, LCSW, LPC (as allowed by applicable state laws), Marriage and Family Therapist, LMSW, or RN required.
- Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
***May be hired as a Behavioral Health Care Manager l,ll, or lll depending upon level of education, skills, and relevant experience.***
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