Career Center

Primary City/State:

Phoenix, Arizona

Department Name:

Behavioral Health

Work Shift:

Day

Job Category:

Clinical Care

Good health care is key to a good life. At Banner Health, we understand that, and that???s why we work hard every day to make a difference in people???s lives. Do you like the idea of making a positive change in people???s lives ??? and your own? If so, this could be the perfect opportunity for you. ??Innovation and highly trained staff. Banner Health leaders can access the staff and resources they need to bring their vision to life. ??If you???re looking to leverage your abilities ??? you belong at Banner Health. ??

The Behavioral Health Utilization Management Department is a growing department that welcomes Team members with diverse backgrounds in the behavioral health field. BH UM Care Managers are an important member of the Insurance Division that helps ensure Banner Members receive efficient behavioral heath treatments. Many BH UM Care Managers see their job as more than utilization review, risk management and quality assurance, rather ensuring that the right care is delivered to the right person for the right reason, in the right amount and in the right place.??

Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY

This position is the point person for all utilization activities for assigned members. As part of an interdisciplinary team, this position reviews and authorizes behavioral health and substance abuse services in inpatient, residential and outpatient settings using approved medical necessity criteria. Monitors care to ensure treatment is appropriate and effective. This position assesses the member???s plan of care and develops, implements, monitors and documents the utilization of resources and progress of the member through their care, facilitating options and services to meet the member???s health care needs. This position provides telephonic or electronic document review. This position engages internal and external resources to ensure members receive appropriate care plan and discharge planning services. This position monitors for quality of care concerns. Will staff regularly with medical directors. Within the scope of their position and licensure, this position will provide education and recommend alternative care plans for treatment not meeting medical necessity criteria. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective care delivery to members. May conduct prior authorization, concurrent, retrospective, and appeal reviews.

CORE FUNCTIONS

1. Manages individual members across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.

2. Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.

3. Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes.

4. Establishes and promotes a collaborative relationship with physicians, other payers, and other members of the health care team. Collects and communicates pertinent, timely information to fulfill utilization and regulatory requirements.

5. Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care.

6. Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice.

7.??Has the freedom to determine how to best accomplish functions within established procedures. Confers with supervisor on any unusual situations. Positions are facility based with potential for remote work, with no budgetary responsibility. Internal customers: All levels of health plan staff, medical staff, and all other members of the interdisciplinary health care team. External Customers: Hospitals, physicians and their office staff, payers, community agencies, provider networks, and regulatory agencies.

MINIMUM QUALIFICATIONS

Requires master???s degree in social work, counseling or related field or with independent or associate licensure. Licensure in at least one of the following categories as required by state law: Social work, professional counseling or marriage and family. Appropriate licenses include: LCSW, LMSW, LPC, LAC, or Licensed Psychologist. Requires a proficiency level typically achieved with three years clinical experience (i.e. counseling, care management, case management, care coordination in inpatient or outpatient levels of care).

Must have a working knowledge of care management, case management, hospital and community resources. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively independently and in an interdisciplinary team format.

PREFERRED QUALIFICATIONS

Previous experience with behavioral health utilization management.

Additional related education and/or experience preferred.