- Under the direction of the Supervisor of Care Management, the Care Manager is responsible for implementing the Care Management programs in multiple environments including Prior Authorization, Concurrent Review and Care Management. A patient advocacy approach with a seamless integration of services is required and must be balanced within the member?s benefit structure. Emphasis will be placed on continuity of care, assisting members in obtaining access to care, and member education. Participates in the continuum of care that addresses the ongoing needs of the member served by the care management process.
Essential Duties & Responsibilities
- Assesses patient's clinical presentation for medical necessity and appropriateness of proposed evaluation/treatment goals.
- Authorizes inpatient and/or outpatient treatment according to company's stated criteria.
- Clearly and completely documents all initial and concurrent reviews, including, but not limited to diagnosis, symptoms, interventions, goals and plan for next review.
- Closes all cases according to the defined case closure procedure in a timely manner, and in accordance with guidelines established by the department Director.
- Consults with Providers as needed, responds to provider questions with regard to EAP or Managed Care cases.
- Performs provider recruiting duties as needed.
- Serves as liaison to other departments as needed.
- Participates in training of other Care Managers as necessary.
- Completes EAP authorizations as assigned.
- Performs Risk Management Activities as needed.
- Attends weekly Administrative and Peer Review Committee meetings.
- Performs special audits, projects, etc. as required.
- Performs other duties as assigned.
Must have and maintain current, valid and unrestricted licensure required in the state in which you work (LCSW, RN, MFT, PhD)
Government Clearance & US Citizenship Requirement
Minimum two years experience as a behavioral health care managerORAny combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
Knowledge, Skills & Abilities
Knowledge of managed care and EAP principles and practicesUnderstanding of basic computer keyboard operationsEffective and professional oral and written communication skillsAbility to assess a patient?s clinical presentation and proposed treatment plans according to company criteria
DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
Health Net and its subsidiaries are an Equal Opportunity/Affirmative Action Employer - Minorities/Females/Veterans/Disability
About Health Net, Inc.
Health Net, Inc. (Health Net) is an integrated managed care organization that delivers managed healthcare services through health plans and government-sponsored, managed-care plans. The Company operates and conducts its businesses through its subsidiaries. Health Net's health plans and government contracts subsidiaries provide health benefits through its health maintenance organizations (HMOs), insured preferred provider organizations (PPOs) and point-of-service (POS) plans to approximately 6.7 million individuals across the country through group, individual, Medicare, (including the Medicare prescription drug benefit commonly referred to as Part D), Medicaid, TRICARE and Veterans Affairs programs. The Company operates within two segments: Health Plan Services and Government Contracts.