Job Description Summary :|
Provides assessments, referrals and counseling. Conducts telephone assessments, collecting sufficient clinical information to make appropriate referral and certification decision for emergency/urgent referrals that require alternate levels of care. Makes appropriate certification decisions. Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible. Facilitates coordination of care with other managers to assure continuity of care. Evaluates clinical appropriateness of treatment using professional knowledge within ValueOptions clinical and work site guidelines and renders certification decisions or seeks consultations for non-certification decisions. Will facilitate all tracking necessary quality indicators to meet these necessary accrediting bodies (NCQA, URAC). Directs members to an appropriate therapist or EAP provider and reviews care on a regular basis to determine whether treatment meets ValueOptions criteria for medical necessity. Negotiates with provider if treatment does not meet ValueOptions criteria and refers cases to an MD or Clinical Management staff if unable to compromise with the provider. Establish and deliver knowledge about care resources and levels of care availability. Special projects and all other duties as assigned.
Education: Master’s degree in social work, psychology, counseling or a Bachelor’s level RN.
Licensure : Current, valid and unrestricted license in a State or territory of the United States in a mental health field (RN, Ph.D., LCSW/ACSW, LLP, MHC, LPC, etc.).
Prior Work Experience: A minimum of 3 years experience in psychiatric or substance abuse treatment. Experience in settings that include inpatient, partial, and/or outpatient care preferred. Experience as a CEAP or EAP internal/external consultant to a work site area required (for the integrated unit only).
Beacon Health Options
- 2 years ago - save job
Beacon Health Options is a health improvement company that serves 45 million individuals across all 50 states and the United Kingdom. On...