Care Manager, BH
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Job Description
Behavioral health care manager authorizing and reviewing mental health and substance abuse services for Magellan Health members. Coordinating discharges, crisis interventions, utilization reviews and quality improvement.
Responsibilities:
- Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient care settings
- Collect and analyze utilization data
- Assist with discharge planning and care coordination
- Provide member assistance for mental health and substance abuse issues
- Participate in quality improvement projects
- Monitor levels of care to ensure medical necessity and effectiveness
- Provide telephone triage, crisis intervention and emergency authorizations
- Perform concurrent reviews for inpatient, outpatient and other applicable levels of care
- Develop discharge plans with providers and facilities and oversee implementation
- Perform quality clinical reviews, educate stakeholders and make interventions to advance member care
- Provide information about benefits, community resources, managed care programs, policies, procedures and criteria
- Interact with Physician Advisors regarding clinical and authorization questions
- Participate in quality improvement activities, including data collection, tracking and analysis
- Maintain an active workload according to National Care Manager performance standards
- Work with community agencies and propose alternative treatment plans when services do not meet medical necessity criteria
- Participate in network development, including identifying and recruiting quality providers
- Advocate for patients and interact professionally with providers to facilitate treatment
Requirements:
- Current licensure meeting State, Commonwealth or customer-specific requirements
- One or more required licenses/credentials: CEAP, LMSW, LCSW, LSW, LPC or RN
- Necessary degree associated with the required licensure
- Minimum 2 years of experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care 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 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
- Must be licensed in Pennsylvania
Benefits:
- Short-term incentives may be available
- Comprehensive benefits package
- Health, life, voluntary and other benefits
- Benefits and perks supporting physical, mental, emotional and financial wellbeing
- Equal Opportunity Employer
- Tobacco-free workplace
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