Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.4 million individuals, including Health Net's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company's website at
Under the direction of the Supervisor of Care Management, the Care Manager is responsible for implementing the Care Management programs in multiple environments including Prior Authorization, Concurrent Review and Care Management. A patient advocacy approach with a seamless integration of services is required and must be balanced within the member's benefit structure. Emphasis will be placed on continuity of care, assisting members in obtaining access to care, and member education. Participates in the continuum of care that addresses the ongoing needs of the member served by the care management process.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Assesses patient's clinical presentation for medical necessity and appropriateness of proposed evaluation/treatment goals.
Authorizes inpatient and/or outpatient treatment according to company's stated criteria.
Clearly and completely documents all initial and concurrent reviews, including, but not limited to diagnosis, symptoms, interventions, goals and plan for next review.
Closes all cases according to the defined case closure procedure in a timely manner, and in accordance with guidelines established by the department Director.
Consults with Providers as needed, responds to provider questions with regard to EAP or Managed Care cases.
Performs provider recruiting duties as needed.
Serves as liaison to other departments as needed.
Participates in training of other Care Managers as necessary.
Completes EAP authorizations as assigned.
Performs Risk Management Activities as needed.
Attends weekly Administrative and Peer Review Committee meetings.
Performs special audits, projects, etc. as required.
Performs other duties as assigned.
Current licensure required in the state in which you work (LCSW, MFT, PhD)
Minimum two years experience as a behavioral health care manager
Knowledge, Skills & Abilities:
Knowledge of managed care and EAP principles and practices
Understanding of basic computer keyboard operations
Effective and professional oral and written communication skills
Ability to assess a patient's clinical presentation and proposed treatment plans according to company criteria
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
Health Net - 16 months ago