WellCare
Behavioral Health Utilization Management Care Manager (Healthcare)
Provides behavioral health care management services through prospective, concurrent and retrospective evaluation and review of treatment. Determines medical necessity, level of care required and quality of care provided. Coordinates and manages behavioral health services rendered by network and non-network providers to health plan members using InterQual criteria, clinical skills and expertise, persuasive communication and access to care standards to promote cost-effective quality outcomes. Oversees and coordinates all facets of care management including initial contacts, necessary triage, pre-certification, administrative and clinical concurrent review, discharge and aftercare planning/referrals and linkage of patients to appropriate mental health providers and outside agencies for follow-up care.
DEPARTMENT: Health Services-Behavioral Health UM
REPORTS TO: Supervisor, Behavioral Health Utilization Mgmt.
Essential Functions: