Care Manager, BH - Remote

Magellan Health

2d • $64,285 - $102,855 • Remote

About The Position

Under general supervision and in collaboration with other clinical team members, the Care Manager authorizes and reviews utilization of mental health and substance abuse services in inpatient and/or outpatient settings. The role collects and analyzes utilization data, assists with discharge planning and care coordination, supports members with mental health and substance abuse issues, and participates in quality improvement projects.

The Care Manager monitors levels of care for medical necessity and effectiveness; provides telephone triage, crisis intervention, and emergency authorizations as assigned; and performs concurrent reviews for inpatient, outpatient, and other levels of care as permitted by scope of practice and experience. In collaboration with providers and facilities, the role develops discharge plans and oversees their implementation. It also conducts clinical reviews, educates members and providers, and makes appropriate interventions to advance member care.

The position provides information about benefits, community treatment resources, managed care programs, policies, procedures, and criteria. It discusses clinical and authorization questions with Physician Advisors, participates in quality improvement data collection and analysis, maintains an active workload under National Care Manager performance standards, and works with community agencies as appropriate. The Care Manager proposes alternative treatment plans when requested services do not meet medical necessity criteria, may assist with network development and provider recruitment, and advocates for patients while interacting professionally and respectfully with providers.

The listed duties are representative and not all-inclusive; a leader may assign additional or other duties aligned with the intent of the job.

Requirements

• A current license meeting State, Commonwealth, or customer-specific requirements is required.
• One or more of the following licenses is required with the necessary degree: CEAP, LMSW, LCSW, LSW, LPC, or RN. The license and certification section also lists LMFT and state and/or compact-state RN licensure as required.
• At least 2 years of post-degree experience in healthcare, behavioral health, or a psychiatric and/or substance abuse healthcare setting.
• Strong organizational, time management, and communication skills.
• Knowledge of utilization management procedures and mental health and substance abuse community resources and providers.
• Knowledge and experience in an inpatient and/or outpatient setting.
• Knowledge of DSM-V or the most current diagnostic edition.
• Ability to analyze utilization problems and plan and implement solutions that directly influence quality of care.
• Required education listed: Associate degree in Nursing, Bachelor's degree in Social Work, or Master's degree in Social Work.

Responsibilities

• Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient care settings.
• Monitor levels of care for medical necessity and effectiveness.
• Collect and analyze utilization data.
• Provide telephone triage, crisis intervention, and emergency authorizations as assigned.
• Perform concurrent reviews for inpatient, outpatient, and other levels of care as allowed by scope of practice and experience.
• Develop discharge plans with providers and facilities and oversee their implementation.
• Perform quality clinical reviews, educate participants, and make appropriate interventions to advance member care.
• Provide members and providers with information about benefits, community treatment resources, managed care programs, policies, procedures, and criteria.
• Discuss clinical and authorization questions and concerns about specific cases with Physician Advisors.
• 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 treatment plans when service requests do not meet medical necessity criteria.
• Participate in network development, including identifying and recruiting quality providers as needed.
• Advocate for patients and interact professionally and respectfully with providers.
• Comply with applicable security responsibilities, security controls, legal, regulatory, contractual, and internal policy requirements.

Benefits

• Comprehensive benefits package, including health, life, voluntary, and other benefits and perks supporting physical, mental, emotional, and financial wellbeing.
• May be eligible for short-term incentives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree