Care Manager, BH - Remote in PA, Bedford, Somerset Cty

Magellan Health • Somerset, NJ

21h • Hybrid

About The Position

This position is for a behavioral health clinician with experience working with children and adolescents. It is a remote role, but candidates must reside in or near the Bedford/Somerset areas of Pennsylvania to facilitate necessary visits to provider groups. The role requires a current license that meets PA, Commonwealth, or customer-specific requirements. Under general supervision and in collaboration with the clinical team, the Care Manager authorizes and reviews the utilization of mental health and substance abuse services in both inpatient and outpatient settings. Key functions include collecting and analyzing utilization data, assisting with discharge planning and care coordination, providing member assistance for mental health and substance abuse issues, and participating in special quality improvement projects.

Requirements

• Behavioral health clinician with experience working with children and adolescents.
• Reside in/close to the Bedford/Somerset areas to visit provider groups as needed.
• Current license that meets PA, Commonwealth or customer-specific requirements.
• One or more of the following licensure 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 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.
• Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.

Responsibilities

• 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.
• 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, develops discharge plans and oversee their implementation.
• Performs 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.
• Understand, comply with and attest to the security responsibilities and security controls unique to their position.
• Comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Benefits

• Short-term incentives
• Comprehensive benefits package
• Broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees