Children's Behavioral Health Care Manager

About the role

The Children’s Behavioral Health Care Manager (BH CM) works in the Children’s Special Services Department and provides a hybrid approach, including utilization and case management, to support members aged 0-21 years with complex behavioral, medical, and/or developmental health issues.

Responsibilities

• Conducts utilization and quality management activities in accordance with New York State and MetroPlusHealth Utilization Management policies and procedures for diversionary services including, but not limited to HCBS, AOT, and PROS.
• Reviews and approves Plans of Care and HCBS services in collaboration with the CSS Medical CMs and Foster Care Liaison, as indicated.
• Performs telephonic review for diversionary and outpatient services using NYS criteria for HCBS services.
• Communicates with Medical Director regarding all outpatient/diversionary requests for health care services that do not meet medical necessity or appropriate level of care and out of network transfer issues.
• Attends and prepares for Integrated Clinical Rounds meetings which focus on newly enrolled, frequently admitted, high utilizing at-risk children/youth.
• Identifies potentially catastrophic, high-risk medical and behavioral cases, and Transitioning Aged Youth (TAY) and coordinates with Children’s Nurse CM and Foster Care Liaison, as indicated, to provide an integrated approach to case management.
• Provides telephone triage and crisis intervention to callers and, when necessary, assists with ensuring members have access to local services and resources.

Requirements

• Master’s Degree in Social Work or Mental Health Counseling
• Minimum 3 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in managed care utilization review, quality assurance, discharge planning.
• Knowledge of New York State child serving systems is required. Experience working with community and family-based services is preferred.
• Licensure and/or Certification Required: A valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED) is required.

Qualifications

• Previous experience within the Integrated Collaborative Care Model Approach preferred
• Knowledge and experience in children’s physical health and BH services, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, and social service programs, including but not limited to Health Homes, OPWDD (Office for People with Developmental Disabilities), OCFS (Office of Child and Family Services) preferred.
• Experience with chronic condition management, particularly asthma, Diabetes, HIV, Heart Disease
• Knowledge of psychopharmacology, Psyckes, E-Paces, LOCADTR, InterQual, Locus/Calocus, HCS (UAS) MAPP preferred.
• Strong interpersonal and assessment skills, the ability to remain calm and poised with challenging providers.
• Medical Background & Bilingual preferred
• Previous experience with hospitals and other large volume providers to address HEDIS/QARR initiatives, preferred.