Experienced Remote Care Manager – Utilization Management and Behavioral Health Services Specialist

Introduction to blithequark

At blithequark, we are dedicated to providing exceptional healthcare services that make a meaningful difference in the lives of our members. As a dynamic and esteemed organization, we strive for excellence in member service and care management, guided by our core values of integrity, accountability, and a commitment to quality. Our mission is to deliver the highest standard of care, ensuring that our members receive the support they need to thrive. We are now seeking an experienced and compassionate Care Manager to join our team, working remotely to oversee and evaluate Behavioral Health Treatment (BHT) services, including Applied Behavior Analysis (ABA) services, for our eligible members.

Job Overview

In this vital role, you will be responsible for assessing requests for medical appropriateness, verifying referrals according to established clinical guidelines, and ensuring that our members receive the highest quality of care based on medical necessity. As a Care Manager at blithequark, you will navigate a mission-focused environment dedicated to excellence in member service and care management, demonstrating integrity and accountability in all aspects of your work. You will collaborate effectively with team members to fulfill departmental objectives and support both immediate and long-term goals, contributing to the overall success of our organization.

Key Responsibilities

• Navigate a mission-focused environment dedicated to excellence in member service and care management, demonstrating integrity and accountability.
• Collaborate effectively with team members to fulfill departmental objectives and support both immediate and long-term goals.
• Assess requests for medical appropriateness and verify referrals according to established clinical guidelines.
• Collect pertinent medical information for review by the Medical Director and communicate decisions clearly.
• Accurately document all necessary information in the utilization management system, ensuring updates on authorizations are recorded.
• Conduct thorough reviews of submitted documentation for compliance with coding (ICD-10, CPT-4, HCPCS) and coverage guidelines.
• Maintain adherence to established policies and procedures while conducting quality reviews of documents.
• Promptly notify providers and members of decisions made, ensuring timely and effective communication.
• Stay updated on federal, state, and local regulations pertaining to the BHT benefit.
• Identify potential quality concerns and report them as necessary, assisting with case audits when required.
• Participate in additional projects and responsibilities as assigned.

Essential Qualifications

To be successful in this role, you will need to possess a Master’s degree in psychology, social work, counseling, or a related field, along with a minimum of four years of experience in providing ABA or mental health services, including clinical review and treatment plan oversight. You must also hold a current, unrestricted California license (LCSW, LPCC, LMFT, RN with BH experience, BCBA, or BCBA-D). Additionally, you should be able to establish and nurture strong relationships with colleagues and external partners from diverse backgrounds, work autonomously while exercising sound judgment in decision-making, and communicate effectively in both verbal and written formats.

Preferred Qualifications

While not essential, preferred qualifications include experience working in a fast-paced environment, managing multiple tasks simultaneously, and inspiring and motivating team members and external committees. You should also be proficient in Microsoft Office Suite (Word, Outlook, Excel, PowerPoint) and related applications, and be able to adapt to a flexible work schedule that may include evenings and weekends.

Skills and Competencies

To excel in this role, you will need to possess strong organizational, analytical, problem-solving, and project management skills. You should be able to work effectively in a remote environment, using technology to communicate and collaborate with team members and stakeholders. Excellent communication and interpersonal skills are also essential, as you will be working with members, providers, and other stakeholders to deliver high-quality care and services.

Career Growth Opportunities

At blithequark, we value your professional development and offer numerous opportunities for skill enhancement and career advancement within the healthcare sector. As a Care Manager, you will have the chance to develop your skills and expertise in utilization management and behavioral health services, and to take on new challenges and responsibilities as you grow in your career. Our organization is committed to supporting the ongoing education and training of our staff, and we offer a range of professional development opportunities to help you achieve your career goals.

Company Culture and Values

At blithequark, we foster a collaborative environment that emphasizes high-quality performance and member service, nurturing a culture of dignity and respect. We believe in the importance of teamwork, communication, and mutual respect, and we strive to create a work environment that is supportive, inclusive, and empowering. Our values are guided by a commitment to excellence, integrity, and accountability, and we expect all staff members to uphold these values in their work.

Networking and Professional Opportunities

In this role, you will have the chance to collaborate with a dedicated team of healthcare professionals, enhancing your professional network and skillset in the healthcare community. You will also have opportunities to participate in industry events, conferences, and training sessions, and to contribute to the development of best practices in utilization management and behavioral health services.

Compensation and Benefits

At blithequark, we offer a competitive salary commensurate with experience, as well as a comprehensive range of benefits, including health, dental, and vision insurance, a retirement savings plan with company matching contributions, and generous vacation and paid time off policies. We also offer a range of perks and benefits, including flexible working arrangements, professional development opportunities, and a supportive and inclusive work environment.

Conclusion

If you are a motivated and compassionate healthcare professional looking for a challenging and rewarding role, we encourage you to apply for the position of Care Manager at blithequark. As a remote worker, you will have the flexibility to work from home, using technology to communicate and collaborate with team members and stakeholders. You will be part of a dynamic and esteemed organization that is dedicated to delivering high-quality healthcare services, and you will have the opportunity to make a meaningful difference in the lives of our members. Don’t miss this opportunity to join our team and take your career to the next level – apply now to become a Care Manager at blithequark.