ABOUT OUR COMPANY
ValueOptions ® is a health improvement company that serves more than 32 million individuals. On behalf of employers, health plans and government agencies, we manage innovative programs and solutions that directly address the challenges our health care system faces today. A national leader in the fields of mental and emotional wellbeing, recovery and resilience, employee assistance, and wellness, ValueOptions helps people make the difficult life changes needed to be healthier and more productive. With offices nationwide and a network of more than 130,000 provider locations, ValueOptions helps people take important steps in the right direction. We help them live their lives to the fullest potential.
ABOUT OUR PEOPLE
At ValueOptions, it’s more than a job. Our employees embrace the company vision of helping people lead healthier lives. The over 3,100 employees on our team enjoy challenging career growth in an environment that values integrity, innovation, consumer engagement and joint accountability. Employees have access to comprehensive benefit packages; corporate discounts; continuing education opportunities, including our online learning portal, and more. At ValueOptions we strive to build a boundless culture and community of professionals that includes honest, open and free-flowing communication. We are passionate about the work we do.
If you have a passion to make a difference and a thirst to actively develop your knowledge and skills, join the ValueOptions team!
ABOUT THE POSITION
We are currently seeking a dynamic Complex Care Manager to join our team at our office in Waynesburg, PA. The Complex Care Manager will perform mental health/drug and alcohol reviews for complex individuals receiving behavioral health services.
- Coordinates with other Care Managers to assure that members’ comprehensive treatment needs are met
- Completes telephone assessments and referrals; gathers demographic and clinical information to connect member with appropriate provider, including outpatient treatment as necessary; and for emergency, urgent, and routine referrals
- Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply VBH-PA criteria and renders authorization decisions. Refers cases that do not meet criteria and need non-authorization decision to Peer Advisor
- Applies utilization management policies and procedures for determination of initial, concurrent and retrospective review
- Utilizes clinical rounds/supervision and case consultations with Clinical Supervisor/Manager and Peer Advisor for cases that do not meet medical necessity criteria
Education : Associates Degree or higher
Licensure : RN licensure required
Relevant Work Experience: Minimum of 3 years of experience in psychiatric and substance abuse treatment.
Knowledge, Skills & Abilities :
- Previous managed care experience preferred.
- Must have prior experience in both physical health and behavioral health settings that include inpatient, partial, and/or outpatient care.
- Customer service orientation
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ValueOptions is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.
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