Care Manager, Behavioral Health
2 weeks ago
This is a Full Time position in the Central time zone. The successful candidate will work a variety of shifts, including:
- Sunday: 1pm - 9:30pm
- Monday: 5:30pm - 2am
- Tuesday: 5:30pm - 2am
- Wednesday: 5:30pm - 2am
- Thursday: 5:30pm - 2am
- Friday: OFF
- Saturday: OFF
The ideal candidate will have:
- A current license that meets State, Commonwealth or customer-specific requirements
- One or more of the following licensure: CEAP, LMSW, LCSW, LSW, LPC or RN
- Minimum 2 years experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care setting
- Strong 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 and/or outpatient setting
- Knowledge of DSM V or most current diagnostic edition
The successful candidate will:
- Monitor inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness
- Provide telephone triage, crisis intervention and emergency authorizations as assigned
- Perform concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience
- Develop discharge plans and oversee their implementation in conjunction with providers and facilities
- Perform quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment
- Provide 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
- Interact with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases
- Participate in quality improvement activities, including data collection, tracking, and analysis
- Maintain an active work load in accordance with National Care Manager performance standards
- Work with community agencies as appropriate
- Propose alternative plans of treatment when requests for services do not meet medical necessity criteria
- Participate in network development including identification and recruitment of quality providers as needed
- Advocate for the patient to ensure treatment needs are met
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
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