935 Case Manager
Location: Detroit Michigan
Description: Strategic Staffing Solutions is at present recruited 935 Case Manager right now, this job will be placed in Michigan. More details about this job opportunity please read the description below. Responsible for providing behavioral health utilization management services for health plan members through the implementation and facilitation of inpatient and outpatient initial and retrospective review, and care management processes. Will: provide telephonic case review, authorization, and care management services through treatment plan review and provider consultation utilizing medical necessity criteria; evaluate clinical appropriateness, coordinate care, and assists with discharge planning; identify members who will benefit from case and/or disease management; collaborate with members and providers to develop cost-effective clinical service plans for complex cases; manage member benefits according to the Certificate of Coverage and transition members when benefits have been exhausted; review and monitor provider treatment plans to ensure quality and effectiveness of service; conduct periodic service reassessments to ensure appropriateness, cost-effectiveness, and maximization of member independence; provide education, consultation, and information to members and providers regarding issues of utilization, benefit coverage, and available community and provider panel resources.
A Masters degree in Social Work, Psychology or a related Allied Health discipline or Bachelors degree in Nursing is required. Current State of Michigan registration/certification/licensure is required. Three years of Clinical experience treating mental health and substance abuse disorders is required. Managed care philosophy, policies, and procedures Application of clinical criteria/guidelines for medical necessity, setting/level of care, and concurrent patient management. Behavioral Health and Medical Management processes across the continuum of care. Current standard medical procedures/practices and their application as well as current trends and developments in medicine and behavioral health Current behavioral health and substance abuse treatment practices using alternative care settings and levels of service- acute inpatient, day treatment, partial hospitalization, and home care Cost containment strategies regardless of limitations of policy/benefits available to the member Local/national community resources Diagnostic criteria from DSM-IV-TR and ICD-9 and CPT coding State and Federal HMO regulations preferred Excellent written and verbal communication skills required. Excellent documentation skills required. Excellent customer service and interpersonal skills including the ability to interact with internal and external customers and all levels of the organization required. Strong problem-solving, analytical and decision making skills required. Strong organizational, planning and implementation skills with the ability to handle multiple project and timelines required. Creative and resourceful with good negotiating skills required PC literate Ability to work well with minimal supervision Valid current Michigan driver?s license and personal means of reliable transportation
lhopkins@strategicstaff.com
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This job starts available on: Wed, 25 Jul 2012 09:52:14 GMT