Job Description
Kinetic Personnel Group is currently recruiting a Care Manager ( LCSW, LPCC, LMFT , or RN ) for a Public Health Plan (government entity). This position will be based in Orange County. This 3 billion-dollar a year government public agency is renowned for its work in the community and being a great place to work.
The Care Manager is responsible for the oversight and review of Behavioral Health Treatment (BHT) including Applied Behavior Analysis (ABA) services offered to eligible Public Health Plan members. The incumbent will screen, triage and assess members to determine the appropriate level of care based on medical necessity criteria. The incumbent will review and process requests for authorization of BHT services from behavioral health providers. The incumbent is responsible for utilization management, quality reviews and monitoring activities of BHT services. The incumbent will directly interact with providers for care coordination for BHT/ABA services.
This position will start out as a 6-month Temporary position, with the possibility of conversion to a permanent employee.
Job Duties:
Care Management Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Reviews requests for medical appropriateness. Verifies and processes referrals using established clinical protocols to determine medical necessity. Screens requests for the Medical Director’s review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director’s decision and documents follow-ups in the utilization management system. Completes required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates. Reviews International Classification of Diseases (ICD-10), Current Procedural Terminology (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and existence of coverage specific to the line of business. Performs quality review of submitted documents and ensures the required elements are met by the established protocols, policies and procedures. Mails rendered decision notifications to the provider and member, as applicable. Adheres to utilization management regulations and processing timeframes. Meets productivity and quality of work standards on an ongoing basis. Identifies potential quality issues and fraud/waste/abuse and reports timely to appropriate department. Stays up to date with federal, state and local regulations that pertain to the BHT benefit. Assists with case audits as assigned. Completes care coordination activities as assigned.
Requirements:
Preferred Qualifications:
Job Types: Full-time, Contract, Temporary
Pay: $34.00 - $55.00 per hour
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