CMT Services, Inc. is seeking licensed Clinical Care Managers with experience treating patients with Behavioral Health or Substance Use Disorders. The clinician conducts telephone, fax, and on-line assessments; collects sufficient data to make appropriate referral and authorization decisions for emergent, urgent, and routine levels of substance use or behavioral health care; and consults with physician advisors. Coordinates with providers to assure appropriate, cost-effective utilization of public behavioral health services.
Duties and Responsibilities: Applies utilization management policies and procedures for determination of initial, concurrent and retrospective reviews for all levels of care in the Public Behavioral Health System of Maryland. Make appropriate utilization management decisions by evaluating the clinical appropriateness of the requested treatment plan using sound clinical judgment and the State of Maryland Public Mental Health System’s Medical Necessity Criteria. Collaborate with providers, Core Service Agencies, Local Addictions Authorities, designated Liaisons, and Managed Care Organizations to determine alternate levels of care and to assure continuity of care. Follow workflow associated with identifying/managing provider/consumer utilization outliers. Fully address provider complaints/concerns in a timely manner.
Develop and maintain flexibility regarding fluctuations in case volume and assist in completing special projects as assigned. Conduct clinical assessments of requests for authorization that are received via telephone, fax, and the secure, on-line “Connect” systems. Collect sufficient data to make appropriate referrals and decisions for emergent, urgent, and routine levels of care. Provide brief telephone assessments, counseling, and referrals to consumers in crisis. Gather demographic and clinical information during telephone assessments to better connect consumers with appropriate providers of urgent and non-urgent levels of care. Seek peer adviser consultations for quality of care concerns, utilization outliers, and adverse determinations.
Education: Master's degree in a mental health related discipline or a registered nurse degree (associate or bachelors)
Licensures: Current, valid, and unrestricted license in a state or territory of the United States in a mental health field (RN, PhD, LCSW/ACSW, LMFT, LCADC, LPC)
Relevant Work Experience: 3-5 years direct practice experience in psychiatric or substance abuse treatment settings. Experience in settings that include inpatient, partial, and/or outpatient care preferred. For some roles experience as a CEAP or EAP internal/ external consultant to a work site area may be required.
Contact: Pamela Jones - firstname.lastname@example.org