Join the team of Quest Care Managers; licensed doctorate-level behavioral health professionals with over 100 years of collective experience in the field. We are seeking a licensed clinical therapist or registered nurse; LPC, LCSW, LMFT, PSYCHOLOGIST or RN to perform utilization reviews as a UTILIZATION CARE MANAGER.

GENERAL SUMMARY:  

• Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.
• Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization.
• Liaisons with the treatment provider regarding the identified treatment plan in accordance with concurrent review criteria.
• Assists the treatment provider in identifying and coordinating alternative, least restrictive settings that will provide appropriate and qualitative care while controlling cost.
• Identifies conditions that require case management across the members episode of treatment or between treatment episodes. Collaborates with the treating provider to identify the members needs including those beyond the immediate clinical treatment administered by the provider.
• Coordinates services with medical utilization/care management personnel of other health plans to ensure appropriate, cost effective treatment and identify areas where both utilization management personnel can collaborate.

DEPARTMENT DESCRIPTION:

Quest Behavioral Health is a full service administrator of mental health and substance abuse benefits and Employee Assistance Programs for healthcare organizations, businesses, school districts and other employers in Pennsylvania. Quest is jointly owned by four central Pennsylvania premier health systems, one of which is WellSpan Health. Quest remains dedicated to its original mission, vision, and values statements of providing extraordinary behavioral healthcare. 

Being a part of a large health system offers exceptional benefits. Here are some of the BENEFIT HIGHLIGHTS:

• Comprehensive Benefit Package- a value of up to 35% of your annual salary
• Retirement Plan- employer contribution up to 4% plus a 2% match
• Health, dental, vision, life and disability insurance
• Generous paid time off + six paid holidays
• Wellness Program Incentives- you can save up to $485 per year
• Paid Relocation

Required Skills

Previous quality assessment and utilization management experience.

Required Experience

EDUCATION: Master's degree in psychology or social work required or Psy.D. or Ph.D. preferred

LICENSURE: LPC, LCSW, LMFT, Psychologist OR RN license with certification in Psychiatry

FOR CONFIDENTIAL CONSIDERATION, PLEASE CONTACT:  

Suzanne Wolf, Sr. Talent Acquisition Consultant

WellSpan Philhaven 

Phone 717-675-2803

swolf6@wellspan.org

Previous quality assessment and utilization management experience.