Clinical Care Navigator

Magellan Health

19h • $64,285 - $102,855 • Remote

About The Position

Under supervision of clinical leadership, the navigator is a phone queue based role responsible for answering calls from Magellan members, individual providers, facilities, and customer representatives. May provide utilization management review and authorization of behavioral health (BH) and substance use disorder (SUD) services ranging from outpatient counseling to inpatient levels of care. May assist with connection to Employee Assistance Program (EAP) services including counseling, coaching, Critical Incident Response and Workplace Support Services (WPS). Responsible for triaging calls, determining level of risk, managing crisis calls, and assessing members for all types of risk following Magellan's established crisis call protocols. Navigators will be assigned additional responsibilities based on level of experience. Manage EAP service requests within scope of clinical role including in the moment telephonic consultation, connection to EAP counseling, education and connection to other EAP benefits. Conduct risk assessment and assessment of social determinants of health needs on all calls. Provide WPS Supervisor Consultations, manage requests for Critical Incident Response, submit requests for urgent/routine member appointment searches. (30%) Provides utilization management review and authorization of behavioral health and substance use disorder services ranging from outpatient to inpatient levels of care utilizing applicable Medical Necessity Criteria (MNC) guidelines. Assists members and facilities in coordinating and accessing benefit eligible treatment. (30%) Provide crisis call management. Follow crisis call protocols and connect to emergency services, mobile crisis response, and/or other crisis resources as appropriate. Outreach to members assessed as high risk. (20%) Assist members with accessing benefit eligible EAP, BH or SUD treatment via bed searches and routine/urgent appointment searches. Manage requests and complete outreach for Critical Incident Response event staffing. (10%) When off queue, other responsibilities include completing required corporate and clinical trainings, participation in individual supervision and team meetings, gathering and submitting customer feedback and supporting Magellan holiday phone queue coverage. (10%)

Requirements

• Full clinical licensure with master's degree in social work, counseling, or similar area; License must be active in state employee works/lives.
• Minimum of 2 years' experience post-licensure in healthcare, behavioral health, social work, psychiatric and/or substance use disorder setting.
• Strong organization, time management, and communication skills.
• Knowledge of utilization management procedures, mental health, and substance abuse community resources and providers.
• Knowledge of and experience in inpatient and outpatient settings.
• Knowledge of DSW V or most current diagnostic edition.
• Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.
• Strong computer skills to utilize and navigate various systems.
• Registered Nurse (RN) licensure acceptable for existing staff; all new hires will need to be master's level licensed clinicians.

Responsibilities

• Answering calls from Magellan members, individual providers, facilities, and customer representatives.
• Providing utilization management review and authorization of behavioral health (BH) and substance use disorder (SUD) services.
• Assisting with connection to Employee Assistance Program (EAP) services.
• Triaging calls, determining level of risk, managing crisis calls, and assessing members for all types of risk.
• Managing EAP service requests including telephonic consultation, connection to EAP counseling, education, and connection to other EAP benefits.
• Conducting risk assessment and assessment of social determinants of health needs on all calls.
• Providing WPS Supervisor Consultations.
• Managing requests for Critical Incident Response.
• Submitting requests for urgent/routine member appointment searches.
• Coordinating and accessing benefit eligible treatment.
• Connecting to emergency services, mobile crisis response, and/or other crisis resources as appropriate.
• Outreaching to members assessed as high risk.
• Assisting members with accessing benefit eligible EAP, BH or SUD treatment via bed searches and routine/urgent appointment searches.
• Completing required corporate and clinical trainings.
• Participating in individual supervision and team meetings.
• Gathering and submitting customer feedback.
• Supporting Magellan holiday phone queue coverage.

Benefits

• Short-term incentives
• Comprehensive benefits package
• Health benefits
• Life benefits
• Voluntary benefits
• 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