RPMGlobal
Work Arrangement
Remote Monday through Friday from 8:30 a.m. EST to 5:00 p.m. EST Candidates are required to reside in the Eastern Central Time Zone. Responsibilities
Respond to calls transferred from Member Services for Members who are identified to be in crisis, conduct risk assessments, and based on the assessment of the situation, follow up with crisis workers, police, treatment providers, etc Analyze behavioral health clinical information and historical data to determine utilization management and medical necessity approval decisions for behavioral health level of care Use behavioral health education and experience to develop care plans and determine behavioral health services required for each member on caseload Provide case management and recommend treatment determinations to the assigned caseload based on clinical judgement and care management program description Facilitate, coordinate, and make direct referrals for behavioral health level of care Support behavioral and physical healthcare with a focus on integrated, whole-person, centered care for members. Closely coordinate care with the member/guardian, school system, behavioral health care provider, and, when appropriate, other medical Physical Health providers Facilitate treatment team meetings for members who are not making progress as expected in consultation with the behavioral health providers and discuss barriers to treatment, modifications to the treatment plan, and the need for alternative levels of care Education and Experience
Master's Degreein Social Work, Mental Health Counseling, Psychology, or Nursingrequired Minimum three (3) years postgraduate clinical experience or equivalent combination of education and clinically related work experience Minimum one (1) year of direct practice experience in the Children’s Behavioral Health Service Delivery Systemrequired. Registered Nurse is required to have a Master's degree and two (2) years of experience in Psychiatric Children’s direct practice, Behavioral Health/Psychiatric direct services Licensure
Current and unencumbered LCSW, LSW, LPC, LMFT, or Registered Nurse licensure in Pennsylvania required Skills & Abilities
A comprehensive understanding of Medicaid, Medicare, and commercial managed care systems is required. Knowledge of Pennsylvania’s state and local services for treating mental health and substance use disorders is preferred Thrives in a fast-paced, productivity-focused environment Proficient in using MS Office, including Word, Excel, Outlook, and Teams, and electronic medical record and documentation programs with a high accuracy rate. Ability to communicate in a positive/professional manner both verbally and in writing.
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Remote Monday through Friday from 8:30 a.m. EST to 5:00 p.m. EST Candidates are required to reside in the Eastern Central Time Zone. Responsibilities
Respond to calls transferred from Member Services for Members who are identified to be in crisis, conduct risk assessments, and based on the assessment of the situation, follow up with crisis workers, police, treatment providers, etc Analyze behavioral health clinical information and historical data to determine utilization management and medical necessity approval decisions for behavioral health level of care Use behavioral health education and experience to develop care plans and determine behavioral health services required for each member on caseload Provide case management and recommend treatment determinations to the assigned caseload based on clinical judgement and care management program description Facilitate, coordinate, and make direct referrals for behavioral health level of care Support behavioral and physical healthcare with a focus on integrated, whole-person, centered care for members. Closely coordinate care with the member/guardian, school system, behavioral health care provider, and, when appropriate, other medical Physical Health providers Facilitate treatment team meetings for members who are not making progress as expected in consultation with the behavioral health providers and discuss barriers to treatment, modifications to the treatment plan, and the need for alternative levels of care Education and Experience
Master's Degreein Social Work, Mental Health Counseling, Psychology, or Nursingrequired Minimum three (3) years postgraduate clinical experience or equivalent combination of education and clinically related work experience Minimum one (1) year of direct practice experience in the Children’s Behavioral Health Service Delivery Systemrequired. Registered Nurse is required to have a Master's degree and two (2) years of experience in Psychiatric Children’s direct practice, Behavioral Health/Psychiatric direct services Licensure
Current and unencumbered LCSW, LSW, LPC, LMFT, or Registered Nurse licensure in Pennsylvania required Skills & Abilities
A comprehensive understanding of Medicaid, Medicare, and commercial managed care systems is required. Knowledge of Pennsylvania’s state and local services for treating mental health and substance use disorders is preferred Thrives in a fast-paced, productivity-focused environment Proficient in using MS Office, including Word, Excel, Outlook, and Teams, and electronic medical record and documentation programs with a high accuracy rate. Ability to communicate in a positive/professional manner both verbally and in writing.
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