Care Manager
APS Healthcare - S Portland, ME

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*CONTRACT EXPANSION*
Care Management Positions Available
At APS Healthcare, we are passionate about changing behaviors of all constituents in the healthcare system to improve health, optimize clinical quality, and reduce associated costs. Our mission, quite simply, is to improve the health of those we serve.

APS is seeking a Clinical Care Manager to join this exciting program in our South Portland office. The Clinical Care Manager reviews and authorizes behavioral health services based on medical necessity criteria for MaineCare. The Care Manager assists providers in determining appropriateness of mental health services for members based on medical necessity criteria with the MaineCare program, and participates in special utilization projects in collaboration with Clinical Director and State of Maine DHHS. This key individual assists the clinical department in reaching contractual goals, and supports the organizational goals of customer service, efficient utilization management, organizational competency and value added care management.

Essential Functions:
• Authorizes treatment for medical necessity for mental health problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care
• Coordinates with APS behavioral health Medical Director and/ or psychiatric physician advisors and other members of the clinical team for authorization decisions.
• Interacts with the Clinical Director, Medical Director, Department of Health & Human Services (DHHS), and other members of the provider clinical team for problem solving and discharge planning as needed.
• Analyzes specific utilization problems, and plans and implements solutions that directly influence quality of care and financial liability.

Education:
• Masters Degree in Social Work, Counseling or related field required.
• Requires licensure as LCSW, LCPC, or LMFT in the state of Maine

Qualifications:
• A minimum of three years related behavioral health clinical experience required.
• Experience in managed care environment preferred.
• Knowledgeable of all levels of care managed by APS Maine Administrative Service Organization (ASO)
• Thorough knowledge of the behavioral health covered benefits for the MaineCare program
• Knowledge of utilization management procedures and mental health community resources and providers
• Ability to assess and authorize treatment for medical necessity for mental health problems, according to clinical information given by providers and criteria for medical necessity and appropriateness of care.
• Strong verbal and written communication skills.
• Above average computer/technical skills.

APS Healthcare - 22 months ago - save job
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