Senior Care Manager - BH

Magellan Health • Maryland Heights Township, MO

2d

About The Position

Authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care settings. Collects and analyzes utilization data. Assists with discharge planning and ambulatory follow up activity; provides member assistance with mental health and substance abuse issues, and participates in quality improvement projects. May be assigned additional special responsibilities commensurate with experience and type of licensure. Will be expected to coach and mentor less experienced Care Managers. Monitors inpatient and intermediate level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness. Performs concurrent reviews for inpatient 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. Provides telephone triage, crisis intervention and emergency authorizations. Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Magellan Health Services policies and procedures, and criteria. Interacts with the company Medical Directors and others to discuss clinical and authorization questions and concerns regarding specific cases. Participates in quality improvement activities, including data collection, tracking, and analysis. Leads or participates in activities as requested that help improve Care Center performance, excellence and culture. Supports team members and participates in team activities to help build a high-performance team. TRFs to be reviewed by Masters level Care Manager only, but RNs may perform all other related duties. 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.

Requirements

• Independent behavioral health licensure: LPC, LCSW
• Master's degree in behavioral health or other related field
• Two year's clinical work experience
• 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.
• Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements.
• Minimum of 5 years of post-degree experience in psychiatric and substance abuse health care.
• Minimum of 3 years of post degree experience for Care Managers with Ph.D.
• Experience to include utilization review.
• Strong organizational, time management and communication skills.

Nice To Haves

• Licensure may also include one or more of the following: CEAP, LMSW, LCSW, LSW, LPC or RN.
• CEAP certification as required by management.

Responsibilities

• Authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care settings.
• Collects and analyzes utilization data.
• Assists with discharge planning and ambulatory follow up activity
• Provides member assistance with mental health and substance abuse issues, and participates in quality improvement projects.
• Monitors inpatient and intermediate level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
• Performs concurrent reviews for inpatient 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.
• Provides telephone triage, crisis intervention and emergency authorizations.
• Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Magellan Health Services policies and procedures, and criteria.
• Interacts with the company Medical Directors and others to discuss clinical and authorization questions and concerns regarding specific cases.
• Participates in quality improvement activities, including data collection, tracking, and analysis.
• Leads or participates in activities as requested that help improve Care Center performance, excellence and culture.
• Supports team members and participates in team activities to help build a high-performance team.

Benefits

• Magellan offers a 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: 5,001-10,000 employees