AmeriHealth Caritas Behavioral Health Care Manager in Chambersburg, Pennsylvania

Behavioral Health Care Manager

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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .


Description

As a member of the Clinical team, the BH Care Manager position is responsible for understanding the Service Delivery System and access to that system. The BH Care Manager will work closely with the PerformCare Member, the Member’s family and providers to determine the appropriate level of care to meet treatment needs. The BH Care Manager is responsible to ensure that treatment delivered is appropriately utilized and meets the Member’s needs in the least restrictive, least intrusive manner possible.

The incumbent will be accountable for the following:

  • Implement all PerformCare Agency and Clinical policies, procedures, and internal processes.
  • Adhere to all documentation requirements for PerformCare Agency and Clinical policies, procedures, and internal processes.
  • Reports utilization trends, clinical issues and operational concerns regarding Service Delivery System to Clinical Care Management Supervisor. Considers all information available to ensure that authorizations are not provided for unbundled, excessive, or duplicative services. Report any atypical or inappropriate authorization requests to Clinical Care Management Supervisor. Report any treatment concerns to Clinical Care Management Supervisor.
  • Review information and document findings from Members, families, providers, and other involved persons to determine an appropriate level of care.
  • Conducts clinical screening, make appropriate determinations regarding level of care based on medical necessity criteria, and complete authorizations within established timeframes.
  • Direct Member care through the authorization of services and discharge planning.
  • On-Call Responsibilities as scheduled.
  • Consult with supervisor to make determinations on exceptional cases. Consult with Medical Director, Assistant Medical Director, Director of Clinical Operations, or Clinical Care Management Supervisor prior to all denials of care.
  • Maintain caseload.
  • Adhere to all policies and procedures including but not limited to: Employee Handbook, Corporate Code of Conduct, Confidentiality and the Corporate Compliance Program, which includes Fraud, Waste and Abuse.
  • Other related duties as assigned

Education/Experience:

  • Master’s Degree.
  • Graduate degree from an accredited educational program in Social Work, Clinical/Counseling Psychology, or Nursing. Direct practice in a Children’s Behavioral Health Level of Care ( ie. BHRS, FBMHS, RTF, etc) .
  • Minimum three years post graduate clinical experience or equivalent combination of education and clinically related work experience. Minimum one year experience working with a managed care system. Minimum one year experience in Behavioral Health Service Delivery System. Knowledge base in Medicaid, Medicare and Commercial Managed Care Systems.
  • Registered Nurse.
  • Required PA licensure for RN, LCSW, LSW, LPC, LMFT, Licensed Psychologist, Licensed Psychiatrist.
  • Demonstrated knowledge of plan benefit information and managed care.
  • PC Skills and Experience utilizing Microsoft Office, Outlook, Excel and PowerPoint.
  • Ability to provide constructive feedback with a focus on improved quality.
  • Ability to communicate in a positive/professional manner both orally and written.
  • Ability to work independently, complete multiple tasks in the allotted timeframe.
  • Strong problem solving skills and decision making skills.
  • Ability to work effectively in a team environment.

EOE Minorities/Females/Protected Veterans/Disabled