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Operating a hospital is more than IV bags and trauma rooms. One might be surprised by the number of people - and the hats they wear - who work behind the scenes to make sure a hospital runs smoothly and safely for our patients, visitors and staff. Each one plays a critical role and is part of a team to ensure the best care for our patients.

As a Behavioral Utilization Care Manager you will be responsible for conducting utilization management functions for the behavioral health department. This is an exciting opportunity to be a part of the health care transformation. We are known nationally as an innovative leader in new health care models, where insurance plans and physicians come together to work collaboratively to make things easier for the member. The division serves over 500,000 members in our community.

The Behavioral Utilization Care Manager will complete corrective action plans, audits, and ensure staffing/coverage needs are met. The schedule for the Behavioral Utilization Care Manager is Monday-Friday; 8-5pm - Opportunities to work remote following in office training.

Accepting applicants in both of our office locations located Phoenix and Tucson:

Phoenix Corporate Office - 2901 N Central, Phoenix, AZ 85004

Tucson Corporate Office - 2701 E Elvira, Tucson, AZ 85756

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

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.

MINIMUM QUALIFICATIONS

Requires master's degree in social work, counseling or related field or with independent or associate licensure. Licensure in at least one of the following categories as required by state law: Social work, professional counseling or marriage and family. Appropriate licenses include: LCSW, LMSW, LPC, LAC, or Licensed Psychologist. Requires a proficiency level typically achieved with three years clinical experience (i.e. counseling, care management, case management, care coordination in inpatient or outpatient levels of care).

Must have a working knowledge of care management, case management, hospital and community resources. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively independently and in an interdisciplinary team format.

PREFERRED QUALIFICATIONS

Previous experience with behavioral health utilization management.

Additional related education and/or experience preferred.

DATE APPROVED 11/03/2019