Medical Director

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Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings. Collects and analyzes utilization data. Assists with discharge planning and care coordination. Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects.
  • Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
  • Provides telephone triage, crisis intervention and emergency authorizations as assigned.
  • Performs concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience. 
  • In conjunction with providers and facilities, develops discharge plans and oversee their implementation. 
  • Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.
  • Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
  • Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.
  • Participates in quality improvement activities, including data collection, tracking, and analysis.
  • Maintains an active work load in accordance with National Care Manager performance standards. 
  • Works with community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. 
  • Participates in network development including identification and recruitment of quality providers as needed. 
  • Advocates for the patient to ensure treatment needs are met.  Interacts with providers in a professional, respectful manner that facilitates the treatment process.

General Job Information

Title

Care Manager BH

Grade

23

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

11/11/2019

Date Requisition Created

11/8/2019

Work Experience

Clinical

Education

Masters (Required), Masters (Required)

License and Certifications - Required

CEAP - Certified Employee Assistance Professional - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Qualifications Education, Training, and/or Experience Knowledge and Competencies:Demonstrates passion and commitment to excellence. Supervises and develops teams of care management staff. Manages human capital resources to optimal performance. Effective oral/written communication and interpersonal skills. Proficiency in use of Microsoft Office tools and care management softwareBi/multilingual ability strongly preferred. Knowledge of managed care concepts and community and home based care. Knowledge of UAS-NY assessment.Managerial experience.Education:Bachelor of Science in Nursing or advanced degree.Licenses, Certifications, etc.: Licensure is required for this position, specifically current license as a Registered Nurse (RN) or Masters or Doctoral-level behavioral health practitioner that meets State, Commonwealth or customer-specific requirements. 3-5 years? experience in utilization review or care management of the chronically ill and disabled in an ethnically diverse population. Managerial experience working within a community based home health organization. Managerial experience working within a Medicaid and Medicare managed care environment.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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