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Care Management OBH Style
Optima Behavioral Health (OBH) is an experienced leader in the delivery of behavioral healthcare management. We have a strong reputation for providing client-focused, innovative and proven services that result in positive treatment outcomes for our members.
Our care managers collaborate with employers, health plans, government and public entities, providers, facilities, and community programs to provide clinically appropriate and cost-effective services.
Results
The results have been consistently high client and member satisfaction ratings. We attain positive results by providing:
- Expert administration of mental health and substance abuse benefits plans.
- Innovative, high-quality Member Service, Care Management, Utilization Management and Quality Improvement programs.
- Clinical management by experienced, licensed mental health professionals for the complete continuum of behavioral health care from outpatient to acute inpatient services.
- Specialized treatment and services delivered in confidential, comfortable settings.
- Attentive coordination and integration of care between "stand alone" Employee Assistance Programs (EAP) and the employer's mental health/substance abuse insurance plans.
- 24-hour access to crisis intervention and emergency services provided by licensed professionals.
Quality
OBH emphasizes quality of care and services for its members and customers. We manage behavioral health services with a uniquely personal touch that enables us to treat the person and help to improve and enjoy his/her life every day.
OBH offers you a team of experienced and caring health care professionals, committed to meeting your needs and providing you with the best mental health care. We can customize our program to meet the specific needs of individuals and employers.
In addition to reviewing care and authorizing reimbursement, our care managers also:
- Consult with members and providers to understand a member’s clinical needs and to make referrals to providers who will provide the needed care.
- Work with providers to "budget" the behavioral health benefit to meet the members' clinical needs in the most effective way.
- Help locate other resources that may be helpful such as community agencies, support groups, etc.
- Monitor the quality of the care our members receive and immediately report any concerns to our Quality Improvement Department for investigation and resolution.
- Identify suitable providers when a member’s condition requires a service or a specialty area that is not available in the network.
- Identify any "gaps" in our provider network in terms of clinical specialties and geographic access and support closing them.
Authorization
Our authorization decisions are made based on:
- Behavioral health care benefits;
- Information supplied by members and providers;
- Our clinical criteria for the various levels of care.
Care managers provide authorization when criteria are met. When criteria are not met, the care manager consults with a peer/physician advisor. The peer/physician advisor contacts the treating provider to discuss the case. If our criteria are not met for the requested care, the peer/physician advisor recommends an alternative level of care that meets our criteria.
If reimbursement is not authorized, the member and provider will receive a letter explaining the decision. The letter also outlines how to pursue an appeal if the member or provider disagree with the decision. During the appeal process, additional information can be supplied by the member and the providers.
Contact
Contact Us and a member service representative or care manager will be able to answer your questions.
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