Utilization Management Manager at Magellan HRSC, Inc.

Posted in Nonprofit - Social Services 18 days ago.

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Type: Full-Time
Location: Richmond, Virginia

Job Description:

Responsible for the management, direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care management staff, providing expertise in designated programs.

ESSENTIAL FUNCTIONS:
- Assists clinical management in the development and on-going management of designated staff.
- Performs care management review activities consistent with Magellan policies, procedures, and standards.
- Conducts recruitment, interviewing, and selection of properly qualified staff members and ensures appropriate orientation is provided.
- Regularly monitors the performance of care management staff. Monitors adherence to the efficiency goals for all staff including case volume, case closure rates, average handle time and other metrics.
- Supervises care management staff through approved audit processes including performing annual reviews and provides counseling and disciplinary action as necessary.
- Coordinates quality improvement activities under the direction of clinical management.
- Assists management in the development of strategic and operational goals and plans.
- Assists management in the identification and coordination of the necessary clinical and client service training needs.
- Analyzes specific utilization problems, plans and implements solutions that directly influence quality of care and cost efficiency.
- Supervises the collection of pertinent clinical information while maintaining a good rapport and relationship with providers.

General Job Information

 

Title

Utilization Management Manager

Grade

26

Job Family

Care Management

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

1/26/2018

Date Requisition Created

1/26/2018

Minimum Qualifications

Education

Bachelors: Nursing (Required), Masters: Behavioral Health (Required)

License and Certifications - Required

LCSW - Licensed Clinical Social Worker - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, PC - Professional Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

5 years post degree experience in a direct care clinical setting; managed care experience preferred. 1 year direct supervisory experience required., Bi/Multilingual., RN licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements., Thorough knowledge of physical, medical specialty and/or mental health community resources and providers. Thorough knowledge of healthcare services in physical health, behavioral health or other medical specialty area based on pod management. Considerable skill in interpreting clinical treatment information and making appropriate referral and triage decisions. Must meet Magellans credentialing criteria for RN, Masters or Doctoral level provider.

Competencies

Language(s)

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled



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