Care Manager
APS Healthcare - Columbia, MD

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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 is quite simply to improve the health of those we serve.

The Care Manager is responsible for performing day-to-day behavioral health/substance abuse care management activities within the guidelines established by APS and under the clinical supervision of a Behavioral Health Medical Director.

This is a telephonic position focusing on utilization management (UM) of mental health and substance abuse benefits at various levels of care. It includes crisis intervention, clinical assessment, triage, continued stay reviews, discharge planning and aftercare follow-up. The Care Manager interacts with medical directors, physician advisors, providers/practitioners, accounts, members and their families, and other internal departments.

Essential Functions:
  • Performs preadmission mental health and substance abuse medical necessity reviews for higher levels of care and documents information gathered and results in system.
  • Performs concurrent mental health and substance abuse medical necessity reviews for higher levels of care and documents information gathered and results in system.
  • Evaluates clinical information and appropriately applies APS medical necessity, TAC and ASAM criteria.
  • Coordinates behavioral health physician review activities with behavioral health medical. directors and/or psychiatric physician advisors
  • Performs crisis intervention when appropriate.
  • Identifies, reports, and follows up on quality concerns as appropriate or directed.
  • Coordination of physical and behavioral health care, as appropriate.
Education:
  • Master's degree in a behavioral health field and appropriate licensure per state requirement.
Qualifications:
  • Minimum of 2-3 years of behavioral health clinical experience is required.
  • Bilingual (English/Spanish) language skills preferred but not required.
  • Knowledge of DSM-IV TR.
  • Knowledge of psychotropic medications.
  • Proficient clinical assessment skills.
  • Ability to comfortably utilize computer. software including Microsoft Outlook, Microsoft Word, Microsoft Excel.
  • Ability to learn new software programs quickly.
  • Conduct clinical conversation and transcribe at a conversational speed.

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