Care Manager (2nd Shirt)

Summary/Position Objectives:
This position is responsible for initial clinical triage and referral activities, pre-authorization and concurrent review of designated levels of care. Ensures that appropriate and timely clinical assessment and referral occur telephonically and in accordance with standards on emergent, urgent and routine intervention. Ensures appropriate application of level of care criteria and that pre-authorization, concurrent review and continued stay authorization occur in a timely and efficient manner. Caseload will be assigned according to need. This position is based in the office and is primarily telephonic interface.

Responsibilities:
Essential Functions:
Triage all calls for emergency, urgent and routine status
Complete telephone assessment of consumer needs and identifies appropriate referral
Assist consumers in providing a referral and obtaining an appointment with a provider
Assist providers with initial authorization and referrals as needed
Review facility admissions for medical necessity and appropriateness in accordance with LOC criteria and policies
Monitor treatment status for continued need and appropriate level of care
Coordinate discharge planning for all hospitalized members by facilitating hospital discharge plans with hospital
Identify and refer members to other agencies or programs when appropriate
Serve as a resource person for, and liaison between, physicians, hospital and other facility based providers as well as individual providers
Maintain documentation in accordance with required policy
Participate in 24-hour coverage of hospital admission reviews/authorization to provide clinical expertise and judgment to authorization technician
Identify and refer members to intensive case management/disease management as necessary; participate with case managers in developing workable solutions
Collect and track data as requested by management
Participate in retrospective review as needed
Assist in new employee orientation as requested
Attend in-service presentations and help identify areas of needed continuing education

ABOUT SCHALLER ANDERSON:

Schaller Anderson administers Medicaid and employer self-funded health plans, and manages behavioral health plans. The company’s suite of services includes member services; provider services; claims processing; information services; financial reporting and analysis; medical management; and grievances and appeals services. Schaller Anderson has also been engaged in several consulting projects for states, health plans and providers. Schaller Anderson and its affiliates have 1,400+ employees nationwide and administer health plans with over 1.6 million members. Recently, the Initiative for a Competitive Inner City and Inc. magazine named Schaller Anderson to the Inner City 100, a list that recognizes the fastest-growing companies in America’s core urban areas. Schaller Anderson placed eighth among 5,000 entries in the Inner City 100 competition and was the only health care management company in the top 10.

The VISION of Schaller Anderson, Inc. is to be recognized as the nation’s foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.


BENEFITS:

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k) and profit sharing
* Tuition reimbursement
REQUIREMENTS
Knowledge and Skills:
Knowledge of Microsoft Office Suite of products and common computer and office hardware.
Skilled in telephonic crisis intervention

Education and Work Experience:
Master’s degree in social work, counseling, nursing, or psychology, or Ph.D. (Psy.D.) in clinical psychology from an accredited university
Licensed to work in the State of Arizona
At least five years of postgraduate clinical experience in a variety of settings and populations