We are currently seeking a dynamic UM Care Manager to join our Prior Authorization Team (PAT) remotely! The Prior Authorization Clinician is an integral part of the clinical team who performs telephonic pre-admission reviews for mental health and substance use services for inpatient and diversionary care settings, for all Beacon national contracts and lines of business.
- This is a remote / work at home position for nights, weekends, and holidays*
Determines appropriate level of care related to mental health and substance use treatment for members based on Beacon’s medical necessity criteria
Pre authorizes treatment for medical necessity for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care.
Provides telephone triage and crisis intervention to callers.
Logs into ACD system for phone coverage of the clinical queue, in a call center environment
Interacts with Physician Advisors to discuss clinical/authorization questions and concerns regarding specific cases
Interacts with providers, crisis teams and facilities in a professional, respectful manner that facilitates the pre authorization process
Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria
Complies with Beacon’s standards for documentation of clinical information, clinical contacts and authorization of care
Complies with regulatory standards and turn-around times
Maintains standard of departments productivity levels
Assists with NCQA, URAC and other QI initiatives
Other duties as assigned
Master’s Degree or higher in a health related field
Current, valid, unrestricted clinical license required (RN, LCSW, MFT, LPCC, PhD or PsyD) is required and incumbent must practice within the scope of license
Relevant Work Experience:
2 years of combined direct behavioral health clinical and managed care experience is required
Knowledge, Skills, & Abilities:
Must be educated in current principles and procedures of behavior health care as well as state specific expertise and knowledge of community resources
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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