Care Manager Behavioral Health (Medical)

TL;DR

Care Manager Behavioral Health (Medical): Implementing utilization management strategies and reviewing healthcare services for behavioral health patients with an accent on resource utilization, quality issue resolution, and member education. Focus on collaborating with providers, analyzing outcomes data, and maximizing member healthcare outcomes through clinical interventions.

Location: Remote (Must be based in Pennsylvania, USA)

Company

hirify.global is a leading healthcare provider and insurer focused on improving member health and provider performance.

What you will do

• Implement utilization management strategies to ensure appropriate healthcare resource usage and quality of care.
• Review healthcare services and apply criteria to identify opportunities for Health Coaching and case management.
• Monitor and analyze healthcare delivery, educating providers and members to improve satisfaction and performance.
• Maintain strict member privacy and adhere to state, federal, and corporate regulatory compliance.
• Collaborate with internal and external stakeholders to streamline care management processes and build rapport.
• Utilize outcomes data to develop and implement strategies for ongoing service improvement.

Requirements

• Must be based in Pennsylvania (USA).
• RN license with High School Diploma/GED OR a Master's Degree for licensed behavioral health professionals.
• 3-5 years of post-licensure experience in Behavioral Health Clinical, Case Management, or Condition Management.
• Proven experience working in a clinical setting.
• Valid license: LSW, LCSW, LPC, LMFT, Licensed Behavior Specialist, or current State/multi-state RN licensure.

Culture & Benefits

• Full-time employment with a specific Sunday-Thursday work schedule.
• Remote work flexibility (Working at Home).
• Commitment to ethical principles and high standards of member privacy.
• Professional environment focused on continuous quality improvement and clinical excellence.