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Care Manager
2 months ago
We are seeking a highly motivated and experienced Care Manager to join our team at Equiliem Healthcare. As a Care Manager, you will be responsible for overseeing and reviewing Behavioral Health Treatment (BHT) services, including Applied Behavior Analysis (ABA) services, to ensure that they meet the medical necessity criteria for our members.
Key Responsibilities:- Screen, triage, and assess members to determine the appropriate level of care based on medical necessity criteria.
- Review and process requests for authorization of BHT services from behavioral health providers.
- Utilize clinical protocols to determine medical necessity and verify referrals.
- Communicate with providers for care coordination and ensure that BHT/ABA services are delivered in a timely and effective manner.
- Perform quality reviews of submitted documents and ensure that they meet established protocols, policies, and procedures.
- Identify potential quality issues and fraud/waste/abuse and report them to the appropriate department.
- Master's degree in psychology, social work, counseling, or a related field.
- 4 years of experience providing ABA and/or mental health services, including experience in clinical review and treatment plan oversight.
- Current CA unrestricted license such as LCSW, LPCC, LMFT, RN (with BH experience), Board Certified Behavioral Analyst (BCBA), or Board-Certified Behavior Analyst - Doctoral (BCBA-D).
- Competitive salary and benefits package.
- Opportunities for professional growth and development.
- A dynamic and supportive work environment.
We are an equal opportunity employer and welcome applications from diverse candidates. If you are a motivated and experienced Care Manager looking for a new challenge, please submit your application today.
