Care Manager Coordinator - Quest Behavioral Health- FT (for Quest internal staff only)

York, PA | Behavioral Health | Tracking Code: 57567

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Position Summary:

General Summary:

 

Under the general supervision of the Director-Care Management, assists in coordinating staff schedules to ensure adequate coverage, assessing Care Management statistics in collaboration with the Director and assists with supervisory referral process.  Provides excellent customer service to members, families and providers.


Duties and Responsibilities:

  1.  Provides coverage for all Utilization/Care Manager functions as needed.

  2.  Coordinates care management schedules and ensures adequate staff coverage 24/7 to meet demands.
  3.  Collaborates with the Manager-Administrative Services and Quest IT analysts in helping to maintain the care manager’s computer system, including access controls, yearly upgrades and protocol revisions.  Assists all Quest staff as an Epic Super User, including communication of changes related to upgrades and LHD documentation.
  4.  Performs responsibilities in a fiscally responsible manner by maximizing utilization of the most appropriate level of care, developing the network by filling treatment gaps and by eliminating inefficiencies.
  5.  Upholds standards of practice based upon the wants and needs of the employers and the employees and their dependents.  Provides a role model for excellent customer service.  Recognizes that employers, employees and dependents, physicians’ practices, care managers, call center staff and providers are all key customers.
  6.  In collaboration with the QM coordinator, assists in developing and implementing quality assessment activities to improve performance, such as by monitoring utilization/care management documentation and activity reports to increase efficiency, maximize resources, enhance customer service and expand access.  Assists in creating custom reports for care management activities/statistics.
  7.  Regularly reviews calls for quality control.
  8.  Regularly reports to the Director of Care Management to assist with the integration and coordination of Quest Care Management operations.
  9.  Assists in monitoring processes to ensure compliance with all regulatory agencies and with incorporating new technologies into the care management operations.
  10.  Effectively addresses member concerns and complaints and appropriately identifies actual and potential risk management situations and reports them to the Director of Care Management.  In conjunction with the Director of Care Management, works with the Director of Call Center and/or any relevant staff when necessary to address these issues.
  11.  In consultation with the Director of Care Management, coordinates with Quality Management when necessary, follows parity and all regulations as a review organization, to ensure timely processing of appeals, pre-certifications, continued stay reviews, denials and discharges in compliance with Commonwealth of Pennsylvania statutes governing Care Management.
  12.  Assists Call Center team with supervisory referral process and tracks and reports these referrals to the Director of Care Management.
  13.  Ensures best clinical practice with all Care Management functions (e.g., crises calls, treatment recommendations, best practices for all levels of care and treatment modalities, etc.) and consults with Director of Care Management and Medical Director when necessary.
  14.  Assists in training and orienting new Care Managers.
  15.  Assists in coordinating the development and implementation of programmatic changes.
  16.  Continuously strives to be a role model in a high performing work team through self-directed learning and encouragement of care manager colleagues.
  17.  Assists with the establishment and maintenance of Care Management policies and procedures, objectives, quality assessment programs, safety and environmental issues.
  18. Complies with all applicable safety regulations; identifies potentially dangerous situations, identifying opportunities to standardize processes and "error proof" systems that will lead to increased safety; and participating in safety education programs and root cause analyses as required.
  19. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
  20. Assists in maintaining departmental reports and records and collecting statistical data for administrative and regulatory purposes.Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.


Department Description:


Quest Behavioral Health is a full service administrator of mental health and substance abuse benefits and Employee Assistance Programs for healthcare organizations, businesses, school districts and other employers in Pennsylvania.

To learn more about Quest Behavioral Health, please click here.
Required Experience

Minimum Education: Doctorate Degree in related field

Minimum Experience: 5 years post graduate experience as a provider of behavioral health treatment services

Min Field of Expertise: Previous quality assessment and utilization management experience 

Required licensure: LCSW, or LPC,or LMFT,or RN (Psych Certified) or Licensed Psychologist

 


Quality of Life

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 1,500 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 19,000 employees, and 170 patient care locations. WellSpan is a charitable, mission-driven organization, committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Quality of Life
Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

Equal Opportunity Employment

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

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