Behavioral Health Utilization Care Manager

Requirements

• Requires master's degree in social work, counseling or related field or with independent or associate licensure. Licensure in at leas

Benefits

Additional Information

Department Name: Work Shift: Day Job Category: Clinical Care Banner Health was recognized on Becker's Healthcare 2025 list of 150+ top places to work in healthcare. This recognition highlights our commitment to supporting team members through comprehensive benefits, opportunities for both personal and professional growth, inclusive and empowering work environments, and resources that promote a healthy work-life balance. The future is full of possibilities. At Banner Plans & Networks, we're changing the industry to reduce healthcare costs while keeping members in optimal health. If you're ready to change lives, we want to hear from you. Banner Plans & Networks (BPN) is an integrated network for Medicare and private health plans. Known nationally as an innovative leader, BPN insurance plans and physicians work collaboratively to keep members in optimal health while reducing costs. Supporting our members and vast network of providers is a team of professionals known for innovation, collaboration, and teamwork. If you would like to contribute to this leading-edge work, we invite you to bring your experience and skills to BPN. As a Behavioral Health Utilization Care Manager , you will be assigned to various hospitals where you will authorize initial admitting and do concurrent reviews for medical necessity. You will be working with facilities and out-patient providers and will collaborate with other reviewers if there is a change to patients continuum of care. You will utilize your clinical experience, excellent collaboration skills, strong time management, and your ability to be a strong communicator to meet requirements for compliancy and member care. Your work schedule will be Monday-Friday primarily 8:00 a.m.- 5:00 p.m. Arizona Time Zone . Your work location will be entirely remote . This position does require Arizona residency for compliance. If this role sounds like the one for you, apply today! POSITION SUMMARY This position is the point person for all utilization activities for assigned members. As part of an interdisciplinary team, this position reviews and authorizes behavioral health and substance abuse services in inpatient, residential and outpatient settings using approved medical necessity criteria. Monitors care to ensure treatment is appropriate and effective. This position assesses the member's plan of care and develops, implements, monitors and documents the utilization of resources and progress of the member through their care, facilitating options and services to meet the member's health care needs. This position provides telephonic or electronic document review. This position engages internal and external resources to ensure members receive appropriate care plan and discharge planning services. This position monitors for quality of care concerns. Will staff regularly with medical directors. Within the scope of their position and licensure, this position will provide education and recommend alternative care plans for treatment not meeting medical necessity criteria. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective care delivery to members. May conduct prior authorization, concurrent, retrospective, and appeal reviews. CORE FUNCTIONS 1. Manages individual members across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes. 2. Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes. 3. Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes. 4. Establishes and promotes a collaborative relationship with physicians, other payers, and other members of the health care team. Collects and communicates pertinent, timely information to fulfill utilization and regulatory requirements. 5. Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care. 6. Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice. 7. Has the freedom to determine how to best accomplish functions within established procedures. Confers with supervisor on any unusual situations. Positions are facility based with potential for remote work, with no budgetary responsibility. Internal customers: All levels of health plan staff, medical staff, and all other members of the interdisciplinary health care team. External Customers: Hospitals, physicians and their office staff, payers, community agencies, provider networks, and regulatory agencies.