Care Manager at Magellan HRSC, Inc.
Posted in Nonprofit - Social Services 14 days ago.
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Location: San Diego, California
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, may develop discharge plans and oversee their implementation. May also perform 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.
- Knowledge of utilization management procedures, mental health and substance abuse community resources and providers
- Knowledge and experience in inpatient and/or outpatient setting
- Knowledge of DSM V or most current diagnostic edition.
- Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.
Education: Master’s Degree in behavioral health field
Field(s) of study: Masters or Doctoral Degree in behavioral health related field
Experience: 3-5 years
Industry: Managed Care
Job Specific: 3 yrs experience post degree in psychiatric and/ or substance abuse health care setting, including utilization review. Associate Care Manager must have performance ratings of “meets expectations” or “exceeds expectations” in order to qualify for this position.
Other: Good organization, time management and communication skills; knowledge of utilization management procedures, mental health and substance abuse community resources and providers; knowledge and experience in inpatient setting; ability to function independently and as a team member; knowledge of DSM IV or most current diagnostic edition. Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.
Computer Skills: Ability to use computer systems
Licenses.: Meets Magellan credentialing requirements for independent professional practice IF performing TRF reviews (Masters level licensed behavioral health professional.)
General Job Information
Job FamilyCare Management
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date2/7/2018
Date Requisition Created2/7/2018
EducationMasters (Required), Masters (Required)
License and Certifications - RequiredCEAP - Certified Employee Assistance Professional - Care Mgmt, LCSW - Licensed Clinical Social Worker - 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
ResponsibilitiesQualifications ? Education, Training, and/or Experience?Knowledge and Competencies:Demonstrates passion and commitment to excellenceSupervises and develops teams of care management staffManages human capital resources to optimal performanceEffective oral/written communication and interpersonal skillsProficiency in use of Microsoft Office tools and care management softwareBi/multilingual ability strongly preferredKnowledge of managed care concepts and community and home based careKnowledge 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 populationManagerial experience working within a community based home health organizationManagerial 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