Beacon Health Options is currently seeking a dynamic UR Care Manager to join our team remotely in Florida! The UR Care Manager performs authorization determinations of mental health and substance use services provided in inpatient, outpatient and/or diversionary care settings. The UR Care Manager applies Beacon’s medical necessity level of care criteria and ensures that all Beacon’s policy and procedure guidelines, external regulatory requirements and URAC/NCQA accreditation standards are met.
*This is a remote, work from home position for applicants licensed in the state of Florida*
- Performs telephonic or paper case review and authorization determinations for certification of admissions into Behavioral Health or Substance Abuse treatment at any level of care.
- Determines appropriate level of care related to mental health and substance use treatment for members based on Beacon’s medical necessity level of care criteria
- Consults with Beacon’s Physician Advisors (PA) when requests for services do not meet medical necessity criteria
- Interacts with Physician Advisors to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases
- Provides information to members and providers regarding mental health and substance abuse benefits and community treatment resources when appropriate
- Recognizes quality of care issues and reports them appropriately through internal and external processes.
- Interacts with providers and facilities in a professional, respectful manner
- Complies with all Beacon’s policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards.
- Demonstrates thorough understanding of product lines and benefit structure for all contracts assigned
- Handles crisis calls when needed
- Participates in rounds with medical director or supervisor to discuss clinical determinations of cases
Education: Master’s degree or higher in a health related field required
Licensures: Current, valid, and unrestricted clinical licensure required in the state of Florida and must practice within the scope of their licensure
Relevant Work Experience: 2 years behavioral health experience required
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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
At Beacon Health Options, our candidate’s data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.