Utilization Care Manager - LPC, LCSW, LMFT or RN

York, PA | Behavioral Health | Tracking Code: 64708

Job Description:

Under the general supervision of the Director-Case Management (Quest Behavioral Health), performs a variety of reviews and applies utilization and case management techniques to determine the most efficient use of resources to support the provision of appropriate, cost effective and quality treatment. Assists in the organizing of utilization reports and revision of clinical policies and procedures as required.

 

Duties and Responsibilities

 

  1. Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.
  2. Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization.
  3. Liaisons with the treatment provider regarding the identified treatment plan in accordance with concurrent review criteria.
  4. Assists the treatment provider in identifying and coordinating alternative, least restrictive settings that will provide appropriate and qualitative care while controlling cost.
  5. Identifies conditions that require case management across the member’s episode of treatment or between treatment episodes. Collaborates with the treating provider to identify the member’s needs including those beyond the immediate clinical treatment administered by the provider.
  6. Coordinates services with medical utilization/care management personnel of other health plans to ensure appropriate, cost effective treatment and identify areas where both utilization management personnel can collaborate.
  7. Assists with the collection and analysis of utilization data and tracks ongoing care management cases and their outcomes.
  8. Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).
  9. Prepares and maintains appropriate documentation as required.
 

Qualifications

  • Minimum Experience:
    • 5 years post graduate experience as a provider of behavioral health treatment services
  • Minimum Education:
    • Master’s Degree in Psychology or Social Work and licensure: LPC, LCSW or LMFT OR
    • BSN Registered Nurse RN with certification in Psychiatry and PhD or PsyD preferred
  • Minimum Field Of Expertise:
    • Previous quality assessment and utilization management experience
Suzanne Wolf
Suzanne Wolf
Sr. Talent Acquisition Consultant
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Why WellSpan Health?

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization comprises a multispecialty medical group of more than 1,600 physicians and advanced practice providers, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 20,000 employees and 200 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.

Employment Benefits

  • Sign-on incentives for new employees (click here for details)
  • Medical, dental and vision insurance
  • Life and accidental death insurance
  • Supplemental life insurance
  • Retirement savings plan
  • Paid time off (PTO)
  • PTO bridging
  • Short-term disability
  • Educational assistance
  • Forgivable loan
  • Flexible spending
  • Credit union
  • Employee recreational activities
  • Childcare
  • Complimentary medicine discounts

Diversity & Inclusion

Welcome. Respect. Value.

Wellspan Health believes that diversity includes all the human characteristics that make each of us similar as well as different. We strive to make every person feel welcomed, respected, and valued while creating a safe and inclusive environment where we all have the individual freedom to express our uniqueness in a respectful manner.

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.

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)