Utilization Management Professional at Magellan HRSC, Inc.
Posted in Nurse 30+ days ago.
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Location: BROOKLYN, New York
Provides ongoing, community-based support for an assigned caseload of health plan enrollees to improve access to care and care coordination. Establishes a relationship with the enrollee, the care coordination team, and providers. Conducts new enrollee outreach and orientation, arranges appointments and transportation as needed. Assists the enrollee in learning to navigate the health care delivery system, community resources, transportation, and effectively use health plan benefits.
- Conducts outreach and orientation for new enrollees. Gathers information needed to ensure continuity of care and permission to share information. Administers Health and Wellness Questionnaire. For hard to reach enrollees, seeks connection by working with the Peer Support Specialist and leveraging community services, care providers, family members, schools, etc.
- Assists enrollees in accessing care and ensures care is received. Helps members, as needed, in selecting providers, making appointments, and planning transportation. Contacts enrollee or provider to ensure appointments have occurred. Assists in transitions of care to and from alternative levels of care or settings. Makes follow up care arrangements and ensures post-hospital care is delivered as planned.
- Meets with enrollee regularly (as determined by individual risks) in order to monitor progress according to the Care Coordination Plan. Reminds enrollee of self-management tools and crisis support. Informs and engages the Care Coordination Team if enrollee has difficulty adhering to the care coordination plan or adhering to treatment and needs additional support.
- Works with enrollee and family/supports to engage in socialization, work or volunteer related activities, or access community resources and services.
- Maintains up to date documentation in the Care Coordination Plan and other Health Services tools. Prepares information for Care Coordination Team meetings and as requested, for shared treatment planning sessions.
General Job Information
TitleUtilization Management Professional
Job FamilyCare Management
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date2/7/2018
Date Requisition Created1/22/2018
EducationAssociates: Nursing (Required)
License and Certifications - RequiredLPN - Licensed Practical Nurse - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
ResponsibilitiesExperience in community service, health care or social services and/or community-based or home health care experience required, Experience with individuals who have severe mental illness or chronic medical conditions., Managed care experience preferred. Experience documenting in a clinical record or information system. Knowledge of local community resources and familiarity with health care coding (ICD, DSM).
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled