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Case Manager
Ref No.: 17-24315
Location: Kenner, Louisiana
JOB DESCRIPTION
                         The Behavioral Health Concurrent Review Clinician utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services

Fundamental Components include:
  • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
  • Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
  • Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
  • Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
  • Identifies members who may benefit from care management programs and facilitates referral
  • Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
QUALIFICATION
  • 3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
  • Must be a Licensed Mental Health Professional with unrestricted LA state license. ABA "Applied Behavior Analysis" certification required.
  • Will consider an out of state license for ABA certification. Managed care/utilization review experience strongly preferred