Behavioral Health Case Manager, Clinical Access Line & Outpatient Managment

This clinical position focuses on precertification review on the clinical access line for behavioral health at the Health Plan and outpatient management. This position provides utilization review and case management in order to ensure timely and appropriate level of care of the membership while in BH acute care, diversionary, or ambulatory levels of care and coordination of care. This position also facilitates coordination and integration of behavioral health, medical management, and social case management. This position reports to the Manager, Behavioral Health Operations. Budgeted salary range is low to mid $50ks. Requirements

To ensure that Network Health members receive timely response to requests and concurrent reviews for behavioral health services and to ensure appropriate level of care of the membership while in acute care, diversionary, or ambulatory levels of care.Conducts precertification of acute, diversionary, and ambulatory levels of care and facilitates access to available community resources. Meet Network Health and MassHealth standards for clinical access line.Interact with department identifying variances to care coordination and specific payment and level of care situations.Conducts utilization review to ensure appropriate outpatient mental health and/or substance abuse outpatient services. Facilitate proactive case management and coordination with BH provider and PCP.Perform case management interventions for the identified population, as appropriate.Coordinate care with medical and social case management.Communicate effectively with Associate Medical Director regarding identified variances or specific members according to criteria utilized for appropriate level of care.Hand-off to disease/program specific diagnosis to appropriate case manager for program admission as appropriate.Provide clinical coverage for the clinical access line and maintain standards for responsiveness.Identify opportunities for improvement and develop action plans when necessary.Salary range: Low to mid $50k's Additional duties

Conduct extended care reviews for ambulatory BH services.Interface with state agencies including DMA, DSS, and DMH to facilitate appropriate care.Collaborate with BH Specialists around clinical network management issues.Participate in task force and other committees.All other related duties as assigned. Qualifications

RN, Masters in Nursing or Social Work or Doctorate in PsychologyTwo years experience in Concurrent Review/Utilization management in behavioral health acute care or managed care. Two years direct clinical experience Solid understanding of different levels of care in behavioral health Medicaid experience a plus. Computer experience Familiarity with decision support systems for level of care criteria a plus Excellent interpersonal, communication, and planning skills. Team player RN, LICSW, LMHC, Clinical Nurse Specialist, or Licensed Psychologist How to apply

Send your resume with a cover letter to careers@network-health.org . Please include the above Job Code in the subject line of your email. Or, mail them to:

Network Health
Attn: Human Resources
101 Station Landing
Fourth Floor
Medford, MA 02155