Magellan Health-posted about 2 months ago
Full-time • Manager
Albuquerque, NM
5,001-10,000 employees

Responsible for the management, direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care management staff, providing expertise in designated programs. Assists clinical management in the development and on-going management of designated staff. Performs care management review activities consistent with Magellan policies, procedures, and standards. Conducts recruitment, interviewing, and selection of properly qualified staff members and ensures appropriate orientation is provided. Regularly monitors the performance of care management staff. Monitors adherence to the efficiency goals for all staff including case volume, case closure rates, average handle time and other metrics. Supervises care management staff through approved audit processes including performing annual reviews and provides counseling and disciplinary action as necessary. Coordinates quality improvement activities under the direction of clinical management. Assists management in the development of strategic and operational goals and plans. Assists management in the identification and coordination of the necessary clinical and client service training needs. Analyzes specific utilization problems, plans and implements solutions that directly influence quality of care and cost efficiency. Supervises the collection of pertinent clinical information while maintaining a good rapport and relationship with providers. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

  • Management, direct supervision and coordination of clinical and/or nonclinical management staff
  • Assists clinical management in the development and on-going management of designated staff.
  • Performs care management review activities consistent with Magellan policies, procedures, and standards.
  • Conducts recruitment, interviewing, and selection of properly qualified staff members and ensures appropriate orientation is provided.
  • Regularly monitors the performance of care management staff.
  • Supervises care management staff through approved audit processes including performing annual reviews and provides counseling and disciplinary action as necessary.
  • Coordinates quality improvement activities under the direction of clinical management.
  • Assists management in the development of strategic and operational goals and plans.
  • Assists management in the identification and coordination of the necessary clinical and client service training needs.
  • Analyzes specific utilization problems, plans and implements solutions that directly influence quality of care and cost efficiency.
  • Supervises the collection of pertinent clinical information while maintaining a good rapport and relationship with providers.
  • 5 years post degree experience in a direct care clinical setting; managed care experience preferred.
  • 1 year direct supervisory experience required.
  • One or more of the following current, active licenses are required: BCBA, LCSW, LMFT, LMSW, LPCC, LPC, PC or RN.
  • If RN, BSN preferred but ASN considered with additional experience.
  • Thorough knowledge of physical, medical specialty and/or mental health community resources and providers.
  • Thorough knowledge of healthcare services in physical health, behavioral health or other medical specialty area based on pod management.
  • Considerable skill in interpreting clinical treatment information and making appropriate referral and triage decisions.
  • Must meet Magellan's credentialing criteria for RN, Masters or Doctoral level provider.
  • This position may be eligible for short-term incentives as well as a comprehensive benefits package.
  • Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
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