Care Manager, BH - Youth, Remote, Idaho licensed

Magellan Health

13d • $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 care settings. The role collects and analyzes utilization data, supports discharge planning and care coordination, assists members with behavioral health concerns, and participates in quality improvement projects.

The position monitors levels of care for medical necessity and effectiveness; conducts concurrent reviews; and provides telephone triage, crisis intervention, and emergency authorizations as assigned. In partnership with providers and facilities, the Care Manager develops discharge plans and oversees implementation. The role performs clinical reviews, educates members and providers, and makes interventions to advance member care.

The Care Manager provides information about benefits, community treatment resources, managed care programs, policies, procedures, and criteria. The role consults Physician Advisors on clinical and authorization questions, works with community agencies, proposes alternative treatment plans when requests do not meet medical necessity criteria, and may assist with provider network development. The Care Manager advocates for members and maintains an active workload in accordance with National Care Manager performance standards. Duties may include additional related responsibilities assigned by a leader.

This is a remote position supporting Idaho and requires Idaho licensure. Candidates residing outside Idaho must also hold a license in their state of residence. The position requires a current license meeting applicable state, commonwealth, or customer-specific requirements.

Requirements

• A current license meeting applicable state, commonwealth, or customer-specific requirements; Idaho licensure is required, and candidates residing outside Idaho must also hold a license in their state of residence.
• One or more of the following licenses with the necessary degree: CEAP, LMSW, LCSW, LSW, LPC, or RN. The listed required certifications also include LMFT and RN state and/or compact-state licensure.
• At least 2 years of post-degree experience in a 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 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 to ensure medical necessity and treatment 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 within 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 resources, managed care programs, policies, procedures, and criteria.
• Consult Physician Advisors regarding clinical and authorization questions and concerns for 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 treatment plans when requested services do not meet medical necessity criteria.
• Participate in network development, including identifying and recruiting quality providers as needed.
• Advocate for members to ensure treatment needs are met and interact professionally and respectfully with providers.
• Comply with role-specific security responsibilities, controls, applicable requirements, and internal policies and procedures.

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