Clinical Care Manager
4 weeks ago
We are seeking a highly skilled Clinical Care Manager to join our team at Magellan Health. As a key member of our clinical team, you will be responsible for authorizing and reviewing utilization of mental health and substance abuse services in inpatient and outpatient care settings.
Key Responsibilities- Collect and analyze utilization data to ensure medical necessity and effectiveness of care
- Assist with discharge planning and care coordination to ensure seamless transitions of care
- Provide member assistance with mental health and substance abuse issues, and participate in special quality improvement projects
- Monitor inpatient and outpatient level of care services to ensure medical necessity and effectiveness
- Provide telephone triage, crisis intervention, and emergency authorizations as assigned
- Perform concurrent reviews for inpatient and 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
- 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 workload 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
- Licensure is required for this position, specifically a current license that meets State, Commonwealth, or customer-specific requirements
- One or more of the following licensure is required for this role with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC, or RN
- Minimum 2 years experience post-degree in healthcare, behavioral health, psychiatric, and/or substance abuse healthcare 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
- Ability to analyze specific utilization problems, plan, and implement solutions that directly influence quality of care
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