Magellan Health, San Diego, CA
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- 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
TitleCare Manager BH
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date11/11/2019
Date Requisition Created11/8/2019
EducationMasters (Required), Masters (Required)
License and Certifications - RequiredCEAP - 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
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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