Case Manager, Behavioral Health (Job ID: 1216), MVP Health Care

Posted: 03/13/18 | SHARE:


MVP Health Care is a nationally-recognized, regional not-for-profit health plan.  We are committed to having a positive impact on the health and wellness of everyone and every community we serve. We care for more than 700,000 members across New York and Vermont, and we are powered by the ideas and energy of more than 1,600 employees – providing a wide range of health benefit plan options with attentive service and flexibility normally associated with a smaller company.  Stop settling for “just a job,” and join a company where you can reach your full potential…and make a positive difference!

Under the direction of the Director of Behavioral Health, the Behavioral Health Case Manager makes triage and referral decisions requiring clinical judgement. The Behavioral Health Case Manager will follow members for mental health, substance abuse and co-morbid medical disorders according to the benefit guidelines and policies across the continuum of care. The Behavioral Health Case Manager will review all requests for inpatient service in view of the appropriate BH and MVP standards, such as Interqual and LOCADTR guidelines, assuring that appropriate follow up of outpatient services occur. The Behavioral Health Case Manager will provide case management/care coordination for members to assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet an individual’s behavioral health needs. The Behavioral Health Case Manager will review requests for all outpatient care plans for both mental health or substance services, using MVP’s Utilization Management programs for entering and tracking cases, correspondence, and documentation. In addition, the Behavioral Health Case Manager will conduct retrospective review of inpatient/outpatient cases and reviews as needed, with supervisors or medical directors.

The Behavioral Health Case Manager will share after hours and weekend on-call responsibilities. The Behavioral Health Case Manager may be required to make site visits to providers or to facilities to attend team meetings to assist in developing relationships and safe, effective alternative service settings. Performs other duties and special projects as assigned. These duties may include representation at Regional Planning Consortiums and as-needed support of transitional activities such as vendor management of the HARP LOB and the children’s carve-in. performs other duties as required.



Minimum Education:

Master’s prepared mental health clinician (LCSW, LMHC), or licensed Registered Nurse (RN).

New York State licensure required with previous mental health or substance abuse experience.

Case Management Certification preferred (ANCC or CCM).

Minimum Experience:

Minimum of 1 year of recent mental health or substance abuse experience required, 2+ years’ experience preferred.

UM or Case Management experience in a managed care organization is preferred.

Knowledgeable with diagnosis and procedural coding, Interqual and ASAM guidelines, psychiatric medication management, hospital case management, and related mental health and substance abuse treatment.

Required Skills:

• Capable of independent thinking with excellent problem solving skills.

• Strong interpersonal, communication and computer skills with the ability to work in a team setting.

• Detail oriented with strong organizational skills including the ability to manage time wisely to meet established deadlines.

• Ability to work in an energetic team environment.

• Experience with situations requiring strict adherence to confidentiality.

• Ability to solve problems while exhibiting clinical judgment and realistic understanding of the current environment.

• Ability to make independent decisions regarding resource utilization, and quality of care.

• Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or care plan and be able to demonstrate good judgment when dealing with emotionally charged situations.

• Strong computer skills including working knowledge of Word, Windows based applications, typing and internet access

Additional Information

Status: Full-Time, Exempt

MVP Health Care is an Affirmative Action/Equal Opportunity Employer). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency, protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at

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