Behavioral Health Care Manager II - Inpatient Care Management (Huntington Beach)

Health Net, Inc. (NYSE: HNT) is among the nation’s largest publicly traded managed health care companies.  Health Net’s mission is to help people be healthy, secure and comfortable.  The company’s POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals.  For more information on Health Net, Inc., please visit the company’s Web site at www.healthnet.com

 

JOB SUMMARY:


Under the direction of the Clinical Supervisor, Care Management, the Care Manager is responsible for implementing Care Management programs in multiple environments including Prior Authorization, Concurrent Review and Care/Case Shaping. 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 AND RESPONSIBILITIES: Assess patient’s clinical presentation for medical necessity and appropriateness of proposed evaluation/facility admission/treatment goals.Proactive case shaping according to evidence-based treatment protocols, taking into account member's prior treatment history/outcome, current presentation, and psychopharmacology regiment. Proactive discharge planning.Authorize inpatient, step-down, and follow-up outpatient treatment according to company’s stated criteria.Clearly and completely document all initial and concurrent reviews, including, but not limited to diagnosis, symptoms, interventions, goals, and plan for next review.Consultation with clinical manager and/or medical director on outlier cases, cases with ambiguous treatment plans, and cases that no longer meet medical necessity for continued treatment.Close all cases according to the defined case closure procedure in a timely manner, and in accordance with guidelines established by the department Director.Consult with Providers as needed, respond to provider questions with regard to EAP or Managed Care cases.Perform provider recruiting duties as needed.Serve as liaison to other departments as needed.Participate in training of other Care Managers as necessary.Perform Risk Management Activities as needed.Attend weekly Administrative and daily Clinical Rounds meetings.Attend monthly clinical in-service trainings, as scheduled.Perform special audits, projects, etc. as required.Other duties as assigned.

 REQUIREMENTS:

 

Education: Master’s degree or PhD or BSN in Nursing.

 

Certification/License:  CA clinical licensure as LCSW, LMFT or Licensed Psychologist or Psych-RN.

 

Experience:  Minimum 2 years experience as a behavioral health care manager.

 

Knowledge, Skills & Abilities:Knowledge of managed care and EAP principles and practices. Knowledge, skill and ability to recognize and work with diagnosis, and treatment of chemical dependency and substance abuse. Understanding of basic computer keyboard operations. Effective and professional communication skills, both in writing and telephonically. Ability to assess a patient’s clinical presentation and proposed treatment plans according to company criteria. Manual dexterity.

OR

Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position. 

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 M/F/V/D.