Posted - May 17, 2022
Responsible for timely, accurate processing of accounts payable vouchers an...
Responsible for timely, accurate processing of accounts payable vouchers and employee expense claims for payment. Research and resolve questions and i...
Posted - May 17, 2022
Responsible for timely, accurate processing of accounts payable vouchers an...
Responsible for timely, accurate processing of accounts payable vouchers and employee expense claims for payment. Research and resolve questions and i...
Posted - May 17, 2022
Master Resilience Trainer - Performance Experts (MRT-PE) support government...
Master Resilience Trainer - Performance Experts (MRT-PE) support government client's program at multiple locations. MRT-PEs teach mental skills, resil...
Posted - May 17, 2022
Master Resilience Trainer - Performance Experts (MRT-PE) support government...
Master Resilience Trainer - Performance Experts (MRT-PE) support government client's program at multiple locations. MRT-PEs teach mental skills, resil...
Posted - May 14, 2022
Provides direct support to organizations and their employees through the de...
Provides direct support to organizations and their employees through the delivery of assessment, consultation, education and triage services. Uses kno...
Posted - May 14, 2022
Provides direct support to organizations and their employees through the de...
Provides direct support to organizations and their employees through the delivery of assessment, consultation, education and triage services. Uses kno...
Posted - May 14, 2022
Overall management of assigned book of business for the company's products...
Overall management of assigned book of business for the company's products and services in order to achieve profitable retention of accounts. Perfor...
Posted - May 14, 2022
Overall management of assigned book of business for the company's products...
Overall management of assigned book of business for the company's products and services in order to achieve profitable retention of accounts. Perfor...
Posted - May 14, 2022
Provide support to all eligible Families with expectant parents and parents...
Provide support to all eligible Families with expectant parents and parents of children from birth to 3 years of age. This program seeks to support yo...
Posted - May 14, 2022
Provide support to all eligible Families with expectant parents and parents...
Provide support to all eligible Families with expectant parents and parents of children from birth to 3 years of age. This program seeks to support yo...
Posted - May 11, 2022
This position is responsible for managing day-to-day operations for manufac...
This position is responsible for managing day-to-day operations for manufacturer invoicing and working directly with manufacturers to resolve any issu...
Posted - May 11, 2022
This position is responsible for managing day-to-day operations for manufac...
This position is responsible for managing day-to-day operations for manufacturer invoicing and working directly with manufacturers to resolve any issu...
Posted - May 11, 2022
Provides professional military personnel support services to the U.S. Navy'...
Provides professional military personnel support services to the U.S. Navy's Identification Card Administration (ICA) program at Navy installations de...
Posted - May 11, 2022
Provides professional military personnel support services to the U.S. Navy'...
Provides professional military personnel support services to the U.S. Navy's Identification Card Administration (ICA) program at Navy installations de...
Posted - May 11, 2022
Evaluates and authorizes approval of prior authorization pharmacy requests...
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinic...
Posted - May 11, 2022
Evaluates and authorizes approval of prior authorization pharmacy requests...
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinic...
Posted - May 11, 2022
This position is in support of schools affiliated with Hurlburt Field. Cand...
This position is in support of schools affiliated with Hurlburt Field. Candidates must be local to Hurlburt Field or willing to relocate to become loc...
Posted - May 11, 2022
This position is in support of schools affiliated with Hurlburt Field. Cand...
This position is in support of schools affiliated with Hurlburt Field. Candidates must be local to Hurlburt Field or willing to relocate to become loc...
Posted - May 11, 2022
Evening Schedule Monday through Friday 11:30AM to 8PM PT Performs prospect...
Evening Schedule Monday through Friday 11:30AM to 8PM PT Performs prospective and/or retrospective drug utilization review and appeals per State and...
Posted - May 11, 2022
Evening Schedule Monday through Friday 11:30AM to 8PM PT Performs prospect...
Evening Schedule Monday through Friday 11:30AM to 8PM PT Performs prospective and/or retrospective drug utilization review and appeals per State and...
Posted - May 11, 2022
Evaluates and authorizes approval of prior authorization pharmacy requests...
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinic...
Posted - May 11, 2022
Evaluates and authorizes approval of prior authorization pharmacy requests...
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinic...
Posted - May 11, 2022
Provide support to all eligible Families with expectant parents and parents...
Provide support to all eligible Families with expectant parents and parents of children from birth to 3 years of age. This program seeks to support yo...
Posted - May 11, 2022
Provide support to all eligible Families with expectant parents and parents...
Provide support to all eligible Families with expectant parents and parents of children from birth to 3 years of age. This program seeks to support yo...
Posted - May 11, 2022
Serves as Lead ID card specialist and may operate as an autonomous service...
Serves as Lead ID card specialist and may operate as an autonomous service provider at a single-person site or as a Team Leader for sites with multipl...
Posted - May 11, 2022
Serves as Lead ID card specialist and may operate as an autonomous service...
Serves as Lead ID card specialist and may operate as an autonomous service provider at a single-person site or as a Team Leader for sites with multipl...
Posted - May 11, 2022
Evaluates and authorizes approval of prior authorization pharmacy requests...
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinic...
Posted - May 11, 2022
Evaluates and authorizes approval of prior authorization pharmacy requests...
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinic...
Posted - May 11, 2022
Care Manager, Behavioral Health - R00000051067 DESCRIPTION/RESPONSIBILITIES...
Care Manager, Behavioral Health - R00000051067 DESCRIPTION/RESPONSIBILITIES:For this position, it requires PA State behavioral health or RN licensure...
Posted - May 11, 2022
Care Manager, Behavioral Health - R00000051067 DESCRIPTION/RESPONSIBILITIES...
Care Manager, Behavioral Health - R00000051067 DESCRIPTION/RESPONSIBILITIES:For this position, it requires PA State behavioral health or RN licensure...
Posted - May 10, 2022
This position is responsible for managing day-to-day operations for manufac...
This position is responsible for managing day-to-day operations for manufacturer invoicing and working directly with manufacturers to resolve any issu...
Posted - May 10, 2022
This position is responsible for managing day-to-day operations for manufac...
This position is responsible for managing day-to-day operations for manufacturer invoicing and working directly with manufacturers to resolve any issu...
Posted - May 10, 2022
Authorizes and reviews utilization of mental health and substance abuse ser...
Authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care settings. Collects and an...
Posted - May 10, 2022
Authorizes and reviews utilization of mental health and substance abuse ser...
Authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care settings. Collects and an...
Posted - May 10, 2022
Under supervision, is responsible for performing referral services to suppo...
Under supervision, is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in...
Posted - May 10, 2022
Under supervision, is responsible for performing referral services to suppo...
Under supervision, is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in...
Posted - May 10, 2022
Plays a key role in medical and pharmacy management initiatives critical to...
Plays a key role in medical and pharmacy management initiatives critical to the company achieving revenue goals and operational objectives. Responsibl...
Posted - May 10, 2022
Plays a key role in medical and pharmacy management initiatives critical to...
Plays a key role in medical and pharmacy management initiatives critical to the company achieving revenue goals and operational objectives. Responsibl...
Posted - May 10, 2022
Responsible for the resolution of clinical appeals. Reviews documentation a...
Responsible for the resolution of clinical appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clin...
Posted - May 10, 2022
Responsible for the resolution of clinical appeals. Reviews documentation a...
Responsible for the resolution of clinical appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clin...
Posted - May 10, 2022
Primary function is to supervise the customer care staff responsible for re...
Primary function is to supervise the customer care staff responsible for responding to telephone inquiries from providers and members as they relate t...
Posted - May 10, 2022
Primary function is to supervise the customer care staff responsible for re...
Primary function is to supervise the customer care staff responsible for responding to telephone inquiries from providers and members as they relate t...
Posted - May 10, 2022
Provides Air Force (AF) personnel, their family members, or intimate partne...
Provides Air Force (AF) personnel, their family members, or intimate partners who are victims of domestic abuse nonclinical emergent and urgent servic...
Posted - May 10, 2022
Provides Air Force (AF) personnel, their family members, or intimate partne...
Provides Air Force (AF) personnel, their family members, or intimate partners who are victims of domestic abuse nonclinical emergent and urgent servic...
Posted - May 10, 2022
This position is a front-line service position providing assistance to Mage...
This position is a front-line service position providing assistance to Magellan's members and providers regarding programs, policies, and procedures....
Posted - May 10, 2022
This position is a front-line service position providing assistance to Mage...
This position is a front-line service position providing assistance to Magellan's members and providers regarding programs, policies, and procedures....
Posted - May 08, 2022
Master Resilience Trainer - Performance Experts (MRT-PE) support government...
Master Resilience Trainer - Performance Experts (MRT-PE) support government client's program at multiple locations. MRT-PEs teach mental skills, resil...
Posted - May 08, 2022
Master Resilience Trainer - Performance Experts (MRT-PE) support government...
Master Resilience Trainer - Performance Experts (MRT-PE) support government client's program at multiple locations. MRT-PEs teach mental skills, resil...
Responsible for timely, accurate processing of accounts payable vouchers and employee expense claims for payment. Research and resolve questions and inquiries from Magellan employees, vendors and providers. Assist management with special projects or tasks as assigned.
Invoice Processing:
Review approved check requests for proper GL coding and approvals.
Review invoices for required information and accuracy.
Prepare invoices and PO invoices for processing.
Scan the prepared invoices into appropriate system. Verify all documents were scanned successfully, and that the populated fields match the information on the invoice. Manually enter missing required information or correct populated information.
Retrieve invoice output file, review the vendor and invoice information on the file, and format the file to import into appropriate system. Verify that the file was imported correctly, and make any necessary corrections to the invoices that were not imported.
Enter the PO detail or the PO invoices. Match the PO invoices to be released. Research any discrepancies between the PO information and the invoice information. Make the necessary adjustments. Contact the Purchasing team for assistance as needed.
File open invoices.
Review T&E's for appropriateness. Release for payment.
Customer Service:
Research inquiries and questions promptly.
In-depth research in Lawson AP and/or GL and OnBase to respond to the inquiry in a professional and accurate manner.
Take the necessary steps to correct errors.
Open communication with supervisor of issues that were not resolved.
Follow up on open issues and strive for timely resolution.
Understand and prioritize tasks to ensure that productivity remains high and there are no negative impacts on team members.
Other Job Requirements
Responsibilities
Strong communication skills (written and verbal) with a customer service attitude with all levels of employees and vendors.
Demonstrated ability to deal professionally with vendors and internal customers.
General to intermediate knowledge of Microsoft Office Suite, specifically Word and Excel.
Ability to easily learn new software.
Must be proactive on issues/problems.
Must be able to understand and prioritize tasks.
General Job Information
Title
Senior Accounting Coordinator
Grade
19
Work Experience - Required
Accounting
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Master Resilience Trainer - Performance Experts (MRT-PE) support government client's program at multiple locations. MRT-PEs teach mental skills, resilience and performance enhancement techniques to military Soldiers, Families and DA Civilians. Teaching is conducted in group and individual settings and includes general education in human performance along with personalized training on how to acquire and apply specific mental skills and techniques that cultivate the mental and emotional strength necessary to thrive in an environment of overwhelming demands and persistent conflict. The mental skills and techniques taught by the program include: Building Confidence, Goal Setting, Attention Control, Energy Management, Integrating Imagery and Team Building. Using these principles, MRT-PEs help the clients to become high performing -tactical athletes- and help foster high performing -unit teams- in preparation for, during, and following combat operations. Specifically, MRT-PEs teach performance psychology to further promote excellence and efficiency during physical, technical and tactical training, as well as during the challenges of combat operations. MRT-PEs also provide tailored education to facilitate Wounded Warriors in their transition back to their units or to civilian life. The program teams are comprised of 5-10 MRT-PEs and led by a seasoned Site Manager with prior military experience.
Attends training exercises and field operations as requested by individual units to serve as a performance enhancement consultant and to coach the clients and leaders on the acquisition of performance psychology techniques and their application to individual military tasks and unit operations.
Provides tailored educational programs and workshops to help Families and Civilians living and working in demanding environments achieve success and accomplish personal, professional and family goals.
Recommends improvements to all aspects of the program operations.
Performs routine program operational duties.
Conducts assessment, assists in program evaluation and supports research projects being conducted locally.
Assists or provides program overview briefings to VIPs and high-ranking leaders when required.
Develops and maintains professional development relating to all aspects of performance enhancement, academic proficiency and military-related knowledge.
Other Job Requirements
Responsibilities
Master's or Doctoral degree from an accredited college or university in the field of Psychology or Kinesiology with a specialized emphasis in sport and/or performance psychology.
Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices on most or all workdays.
Ability to communicate and interact with others, both in person and/or by telephone to conduct business.
Experience and ability to work under time pressure.
Working rapidly for long periods to meet deadlines.
Must be able to travel as needed and adhere to AFSC travel policies and procedures.
Must be able to enter private homes that may or may not provide easy access for those with physical disabilities or those recovering from physical rehabilitation or post-recovery mobility.
Position requires ability to transport self from office locations to private homes, other offices and facilities where training and other program activities occur.
Physical requirements can typically be characterized as active: Lifting, bending, sitting on the floor, climbing may be required in the position. Requires lifting or moving various pieces of equipment, maximum 40 lbs. Position may require work on hands and knees to conduct program activities.
Ability to manage multiple concurrent tasks and perform under stress.
Requires reading and comprehension proficiency.
Requires effective writing and problem solving skills.
Ability to maintain confidentiality.
Customer contact expertise.
Travel requirement: 25%.
General Job Information
Title
Master Resilience Trainer - Performance Expert, ARD
Grade
22
Work Experience - Required
Work Experience - Preferred
Education - Required
Masters - Kinesiology, Masters - Psychology
Education - Preferred
PhD
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Provides direct support to organizations and their employees through the delivery of assessment, consultation, education and triage services. Uses knowledge of federal regulations to assist organizations in their appropriate handling of employee concerns and problems. Consults with employees and organizations on variety of workplace and work based issues. Provides clinical expertise in order to restore employees with diminished performance to healthy functioning. Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings.
Provides employee consultation related to specific personal problems and concerns. Provides crisis assessment and intervention as needed.
Completes clinical and administrative documentation and required forms in a clear and concise manner.
Manages caseload and other tasks to meet both qualitative and quantitative performance expectations.
Provides behavioral health assessments, accurate clinical diagnoses, and referral to appropriate level of care. Provides expert consultation to employees and/or supervisors on a variety of workplace and work based issues.
Provides information and referral to community resources as appropriate.
Provides clinical consultation/staffing in absence of EAP Manager.
Participates in activities as requested that help improve SBU and/or client performance, excellence and culture.
Support team members and participate in team activities to help build a high-performance team.
Demonstrates flexibility in areas such as job duties and schedule to aid in better serving its members and help Magellan achieve its business and operational goals.
Assists in efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
Provides telephone triage, crisis intervention and emergency authorizations as assigned.
Participates in quality improvement activities, including data collection, tracking, and analysis.
Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
Other duties as assigned.
Other Job Requirements
Responsibilities
2 years post graduate clinical experience.
Clinical training must include instruction on chemical dependency, mental health and brief therapy.
Must have understanding of workplace issues, how businesses function and a fundamental understanding of employee/ employer relationships.
Must be capable of acquiring an understanding of EEO rules, ADA in the workplace, FMLA, and Drug Free Workplace Requirements.
Must be able to provide accurate client assessment including level of risk, substance abuse and dependency, job performance issues and refer to appropriate level of care.
Competent in crisis intervention.
Demonstrate knowledge and expertise in solution-focused, brief therapy in outpatient setting. Strong customer service skills required.
Must be able to sensitively, compassionately respond to callers. Excellent listening skills vital.
Interact effectively at all levels both within the company and with external customers.
Analyze and present issues in a clear, concise, persuasive manner, both orally and in writing.
Use time to manage caseload and documentation effectively.
Meet productivity targets and quality management expectations.
Develop effective working relationships with peers within and across organizational lines.
Effectively resolves individual conflicts.
Supports department mission and keeps management informed of team issues.
Takes responsibility for own development and stays current on skills and techniques needed to perform job.
Flexible; adjust well to new situations and changing priorities.
Comfortable with ambiguity and stress while handling a variety of assignments.
Maintain a positive, achievement-oriented attitude and consistent in accomplishing expected objectives.
General Job Information
Title
After Hours Care Manager
Grade
23
Work Experience - Required
Clinical, Employee Assistance Program (EAP)
Work Experience - Preferred
Education - Required
Masters - Behavioral Health
Education - Preferred
License and Certifications - Required
Current licensure required for this position that meets State, Commonwealth or customer-specific requirements - Care Mgmt, LCSW-C - Licensed Certified Social Worker - Clinical - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, Must be an independently licensed behavioral health clinician - Care Mgmt
License and Certifications - Preferred
CEAP - Certified Employee Assistance Professional - Care Mgmt
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Overall management of assigned book of business for the company's products and services in order to achieve profitable retention of accounts.
Performs daily operation-specific duties that directly relate to the products and/or services assigned.
Develops and maintains multi-level relationships within client organizations which includes maintaining contract requirements. Communicates and updates account service information to appropriate internal staff. Makes presentations to the professional community in order to enhance the visibility and image of the company.
Provides high level consultation to customers, including fiscal management support.
Demonstrates knowledge of the company's products and services, and how multiple products and services are interdependent within the customer contract deliverables and clinical outcomes. Maintains in-depth knowledge of client organization.
Effectively explains or uses technology (internally and externally) for customers.
Demonstrates and implements strategic profitable products or services that includes demonstrating the knowledge of the dynamics facing managed care in the current market.
Understands about the company's business and operational decisions to predict impacts on customer.
Other Job Requirements
Responsibilities
Based on client contract, may require clinical licensure in good standing (RN, LCSW, LMHC, LPC, Pharmacist) for state in which work is performed.
Recent Sales or Account Management experience in related industry/field.
General Job Information
Title
Account Manager II (REMOTE)
Grade
24
Work Experience - Required
Account Management, Sales
Work Experience - Preferred
Education - Required
A Combination of Education and Work Experience May Be Considered., Bachelors
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Provide support to all eligible Families with expectant parents and parents of children from birth to 3 years of age. This program seeks to support young military Families which directly contribute to military mission readiness, support Family members' adaptation to military life, enhance the knowledge and skills for healthy relationships that can provide safe, nurturing environments for children to prevent family violence. Provide activities and services including information and referrals, parenting programs, respite care for children, and supervised play time for children. Families with children prenatal to 3 years old who have been assessed as being at risk for child maltreatment and/or Family violence can benefit from additional, more-intensive support from these services.
Provides effective, timely and confidential services for Families who have been assessed as being at risk for child maltreatment and/or Family violence.
Protects the privacy and confidentiality of client information.
Identifies and reports suspected child abuse and neglect and domestic abuse.
Assesses developmental milestones and referral procedures for indicators of special needs or developmental delays.
Assesses and strengthening adaptation to parenthood.
Assesses and strengthening parental capacity for problem-solving, building and sustaining trusting relationships, and seeking help when necessary.
Promotes developmentally appropriate parenting skills and disciplinary techniques, and parent and child communication skills.
Facilitates informal and formal community networks to build positive relationships and reduce social isolation.
Develops relationships with local community and military installation officials and organizations that can maximize program effectiveness.
Utilizes community-based services and formal and informal community networks to provide concrete support for families who may be in crisis.
Utilizes methods for screening for, assessing, and addressing protective and risk factors associated with child abuse and neglect using a strengths-based Family centered developmental approach.
Keeps tracking system up to date with case status.
Participates in monthly conference calls and annual training events.
Other Job Requirements
Responsibilities
Qualified candidates must have at least two (2) years of direct work experience in child abuse or domestic abuse, or maternal or child health or medical social work.
Must hold a current and active license as an LCSW, LMFT or RN.
Licensed Clinical Social Workers must possess a current, valid, unrestricted clinical license and a master's degree in Social Work to practice social work independently.
Registered Nurses must have at least a bachelor's degree in nursing, a current unrestricted license in one of the States or U.S. territories, and at least two (2) years of direct work experience with child abuse or domestic abuse, maternal or child health, public/community health, or mental health.
Must have home visitation experience.
Must have a valid driver's license, auto insurance and ability to operate a motor vehicle.
Must have working knowledge of basic computer skills and be able to use Microsoft Word, Power Point, and Excel programs.
Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices on most or all workdays.
Ability to communicate and interact with others, both in person and/or by telephone to conduct business.
Working under time pressure.
Working rapidly for long periods to meet deadlines.
Must be able to travel as needed and adhere to AFSC travel policies and procedures.
Must be able to enter private homes that may or may not provide easy access for those with physical disabilities or those recovering from physical rehabilitation or post-recovery mobility.
Position requires ability to transport self from office locations to private homes, other offices and facilities where training and other program activities occur.
General Job Information
Title
New Parent Support Program Child and Family Specialist, FASS
Grade
21
Work Experience - Required
Child Welfare
Work Experience - Preferred
Education - Required
Bachelors - Nursing, Masters - Counseling, Masters - Social Work
Education - Preferred
License and Certifications - Required
LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
This position is responsible for managing day-to-day operations for manufacturer invoicing and working directly with manufacturers to resolve any issues. Will remain up-to-date on current processes and concerns. Will be required to consistently meet established timeliness for service level agreements and quality objectives.
Maintains a clear understanding of rebate client contractual requirements, ensuring compliance with service level agreements.
Understands and adheres to departmental policies and procedures.
Processes quarterly manufacturer rebate invoicing for assigned clients or manufacturers.
Reviews invoicing practices, including pre-invoicing quality reviews and adjustments for fee for service, managed care, diabetic supply and supplemental rebate programs.
Produces reports, including federal rebate 64.9R.
Works directly with manufacturers pertaining to dispute resolution.
Acts as primary contact for manufacturers to answer/resolve rebate questions.
Conducts quality validation and approval of claim files.
Other Job Requirements
Responsibilities
2+ years of experience in customer support, analysis or business, preferably within a financial environment.
Associate's degree required or an additional 2 years of relevant experience in lieu of degree.
Strong verbal and written communication skills.
Strong working knowledge of Microsoft Word and Excel.
General Job Information
Title
Pharmacy Rebate Specialist, Government
Grade
19
Work Experience - Required
Customer Service, Operations
Work Experience - Preferred
Education - Required
A Combination of Education and Work Experience May Be Considered., Associates
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
CPT - Certified Pharmacy Technician - Pharmacy
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Provides professional military personnel support services to the U.S. Navy's Identification Card Administration (ICA) program at Navy installations designated as Defense Enrollment Eligibility Reporting System (DEERS) and Real-time Automated Personnel Identification System (RAPIDS) sites.
Serves as ID Card/Common Access Card (CAC) customer service specialist trained and certified by the Defense Manpower Data Center (DMDC).
Delivers ID Card services to all personnel assigned to support customer commands, other military service personnel, retirees and their dependents, and contractors verified through the Trusted Associate Sponsorship System (TASS).
Performs as a Verifying Official (VO) on DEERS/RAPIDS terminal and ensures inputted data for accuracy and correctness.
Verifies the identity and eligibility of authorized DoD beneficiaries, issues DoD Identification Cards and performs DEERS updates in accordance with DoD regulations and AFI 36-3026.
Issues and strictly controls Armed Forces identification and privilege cards for all eligible personnel, (i.e., active duty military, retired military, 100% Disabled American Veteran (DAV) and respective dependents and verified contractors.
Operates and maintains RAPIDS workstations, processes CACs, assists customers with questions concerning identification card eligibility, application requirements and DEERS, and answers telephone inquiries.
Accomplishes DEERS enrollment and updates for all eligible beneficiaries, reconciles erroneous DEERS information, performs PIN resets, verifying and updating PKI certificates, and provides other ICA services as necessary.
May also be certified by DMDC as Site Security Manager (SSM) with responsibility for the safekeeping, storing, and accountability of the CAC and related consumable materials.
Maintains RAPIDS equipment within the physical parameters and configurations established at the time of installation.
Performs -User Maintenance on RAPIDS equipment.
Other Job Requirements
Responsibilities
High School diploma or equivalent.
1+ years' experience in a Customer Service environment.
HR background in one of the following disciplines: Military Pay, Military Personnel, Travel Claims or Navy Transportation.
Substitutions for HR background can be from similar experience gained in either the private sector or other Federal Agency.
Proficient in both oral and written communication to communicate effectively and explain complex actions regarding military entitlements, allowances and collections.
Working knowledge of Microsoft Office Products, i.e. Word, Excel, Power Point.
Working knowledge of standard office equipment such as computers, electric typewriters, copiers, fax machines, scanners and other office automation systems.
Must be U.S. citizen and possess favorably adjudicated Tier 3 (NACLC) security investigation.
General Job Information
Title
ID Card Specialist (Personnel Assistant II)
Grade
WDNICAPAII
Work Experience - Required
Customer Service
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
Researches, resolves and documents prior authorization outcomes in pharmacy system.
Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
Escalates requests to Pharmacist when request requires extensive clinical review or denial.
Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
Performs other duties as required.
Other Job Requirements
Responsibilities
Must have an active pharmacy technician licensure or registration in accordance with state requirements.
If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).
In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).
Active Pharmacist license supersedes requirement for CPT and/or PTCB.
Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
Excellent written and verbal communication skills.
Ability to follow clinical criteria and instructions to approve prior authorization requests.
Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
Ability to identify and trouble-shoot problematic issues.
General Job Information
Title
Clinical Pharmacy Technician I
Grade
17
Work Experience - Required
Pharmacy
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
This position is in support of schools affiliated with Hurlburt Field. Candidates must be local to Hurlburt Field or willing to relocate to become local and be licensed at the independent level in the state of Florida as a Mental Health Counselor ( LMHC ), Therapist ( LMFT ), or Social Worker ( LCSW ).
This position has the primary responsibility of providing the full breadth of Child and Youth Behavioral (CYB) counseling services to children of all ages of military service members and their families at military installations and off military installations. These services may include non-medical counseling, training/ health and wellness presentations, consultation with parents, personnel, schools, and consultation to installation command regarding behavioral health issues affecting children and youth. CYB School counselors will be assigned to Department of Defense (DoDEA) schools and community schools and will need to have experience working in a school setting to qualify for school position. CYB School counselors will also be assigned to youth programs, summer camps, and on demand assignments. The counselors work closely with the installation and military branch Points of Contact (POC) to assure that the program is provided within scope and meets the needs of the installation and the schools.
Provides non-medical, short-term, solution focused, counseling directly to children and youth of service members. Services include assessment, brief counseling and consultation, action planning, referral to resources (assuring linkage as appropriate), and follow-up as indicated.
CYB counselors will also have a focus on supporting the staff and personnel of DoDEA and community schools, and summer camps as well as providing parent training and guidance.
Provides training and health and wellness presentations, participates in health fairs and other base/installation activities focused on children and youth.
Enters counselor activity data on a daily basis through smart phone, or web application, to assure that reporting is accurate from assigned installation while maintaining confidentiality and anonymity of service/family member.
Creates a presence in the school; is available to children, youth, and staff. When working with children, the counselor must abide by line of sight protocol (another adult with responsibility for the child must be able to see the counselor and child they are working with at all times).
Establishes and maintains working relationships with community resources focused on children and youth and provides appropriate linkages.
Partners with POC to provide CYB services in a manner that addresses the needs of the installation/facility. Develops an effective and professional working relationship with the installation/facility POC.
Manages duty to warn and restricted reporting situations according to DoD protocol and staffs the cases with Regional Supervisor/Regional Director.
Communicates with Regional Supervisor and participates in regular individual and group supervision, sharing information regarding trends and issues on the installations and in facilities to which they are assigned.
Responds to critical incidents and special requests as directed by the POC and approved by the Office of Secretary of Defense (OSD) program manager. The CYB will flex schedule to respond to urgent requests as needed.
Participates in regular in-services/training, Quality Improvement committees or other contract activities as assigned/appropriate.
Other Job Requirements
Responsibilities
Master's degree from an accredited graduate program in a relevant field of study to include, but not limited to, a mental health related field such as social work, psychology, marriage/family therapy, or counseling.
Valid unrestricted counseling license from a State, District of Columbia, US Territory or Commonwealth that grants authority to provide counseling services as an independent practitioner. For assignments in the 50 states, counselors shall be licensed or certified in the state in which the client is receiving services.
Minimum 2 years of post-masters supervised clinical experience.
Requires ability to engage and communicate with military members or children as assigned, in order to accomplish job functions, and to respond quickly to emergent situations in any physical location on a military installation and/or within a school setting, which includes the need to traverse short and/or long distances within the base to both indoor and outdoor locations, to maneuver through rugged, outdoor or uneven locations (e.g., steep inclines, stairs, grass), and work in outdoor weather and other military base conditions.
May require travel to locations outside of a military base in a variety of physical environments.
Due to the nature of working on military installations or related worksites, counselors may need to comply with various site-specific requirements to work at designated locations. For example, for some assignments, counselors will need to have certain immunizations or vaccinations and provide record of receipt.
Ability to prove US Citizenship and must be fluent in English.
Understanding, sensitivity and empathy for service members and their families. Ability to develop trusting, helping relationships. Ability to work with individuals and families from diverse racial, ethnic and socioeconomic backgrounds.
Must pass a National Agency Check and Inquiries (NACI) Clearance, and an Installation Records Check (IRC), Criminal Background Check, and FBI Fingerprints Check.
Vehicle Operator's License Requirement: Unless specifically waived by the FEDSIM COR, all contractor personnel providing counseling support at Government locations shall possess a valid U.S. state vehicle operator's license. As a condition for employment under this contract, contractor personnel may be required to pass all tests for and obtain a U.S. military vehicle operator's permit for commercial sedans and similar, for use at Temporary Duty (TDY) locations, if required.
General Job Information
Title
Military and Family Counselor - School
Grade
MFLC Tier 2
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Masters - Behavioral Health, Masters - Social Work
Education - Preferred
License and Certifications - Required
Current licensure required for this position that meets State, Commonwealth or customer-specific requirements - Care Mgmt, DL - Driver License, Valid In State - Other, Must be an independently licensed behavioral health clinician - Care Mgmt
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Evening Schedule Monday through Friday 11:30AM to 8PM PT
Performs prospective and/or retrospective drug utilization review and appeals per State and Federal regulations. Participates in the distribution of clinical drug information and educates providers and staff regarding the use of pharmaceutical treatment regimens. Complies with all corporate and facility standard operating procedures, policies, guidelines, and work instructions.
Provides prior-authorization services for formulary drugs, develops programs to provide optimal pharmacy care to patients, participates in drug utilization review programs, reviews assessment and documentation of patient care, and retrospective reviews of provider reimbursement. Makes recommendations to physicians and other prescribers on medication regimens as per plan guidelines. Assists providers to ensure accurate dispensing and billing of products.
Collaborates with other clinical personnel in assessing treatment guidelines. May participate in formulary development and management. Supports the national Pharmacy and Therapeutics Committee. Validates the clinical availability of multi-source products for provider utilization.
Adheres to organizational policies and procedures. Ensures compliance with Federal and State laws and standards of practice which govern the profession of pharmacy. Maintains pharmacy records in accordance with all applicable state and federal laws and regulations. Maintains clinical skills and knowledge of pharmacotherapy by reviewing the literature, continuing education and any company provided in-services. Completes all mandatory company provided on-line courses. Attends and completes all employee development courses.
Participates in mandatory on-call rotation when required by business needs.
Makes outbound or takes inbound telephone calls to assist in various aspects of patient care and/or product distribution to/from practitioners, members, and pharmacies. These calls include, but are not limited to, comprehensive medication reviews, targeted medication reviews, call to practitioners about product awareness, and prior authorizations.
Other Job Requirements
Responsibilities
License must be current and in good standing.
General Job Information
Title
Clinical Pharmacist - Clinical Liaison Team 11:30AM to 8PM M-F
Grade
29
Work Experience - Required
Pharmacy
Work Experience - Preferred
Education - Required
Bachelors - Pharmacy
Education - Preferred
PharmD - Pharmacy
License and Certifications - Required
RPH - Registered Pharmacist - Pharmacy
License and Certifications - Preferred
PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists. Researches, resolves and documents prior authorization outcomes in pharmacy system.
Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
Escalates requests to Pharmacist when request requires extensive clinical review or denial.
Monitors telephone system to ensure adequate staffing to maintain client services levels.
Assesses training needs within the team. Serves as a training resource, mentor and coach to others. Identifies and shares best practices.
Demonstrates, advocates and reinforces a positive team environment.
Other duties as assigned.
Other Job Requirements
Responsibilities
Must have an active pharmacy technician licensure or registration in accordance with state requirements.
If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).
In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).
Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
Excellent written and verbal communication skills.
Ability to follow clinical criteria and instructions to approve prior authorization requests.
Minimum of 2 years dispensing or retail experience required, or equivalent internal training will be substituted.
Ability to identify and trouble-shoot problematic issues.
General Job Information
Title
Clinical Pharmacy Technician II
Grade
18
Work Experience - Required
Pharmacy
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Provide support to all eligible Families with expectant parents and parents of children from birth to 3 years of age. This program seeks to support young military Families which directly contribute to military mission readiness, support Family members' adaptation to military life, enhance the knowledge and skills for healthy relationships that can provide safe, nurturing environments for children to prevent family violence. Provide activities and services including information and referrals, parenting programs, respite care for children, and supervised play time for children. Families with children prenatal to 3 years old who have been assessed as being at risk for child maltreatment and/or Family violence can benefit from additional, more-intensive support from these services.
Provides effective, timely and confidential services for Families who have been assessed as being at risk for child maltreatment and/or Family violence.
Protects the privacy and confidentiality of client information.
Identifies and reports suspected child abuse and neglect and domestic abuse.
Assesses developmental milestones and referral procedures for indicators of special needs or developmental delays.
Assesses and strengthening adaptation to parenthood.
Assesses and strengthening parental capacity for problem-solving, building and sustaining trusting relationships, and seeking help when necessary.
Promotes developmentally appropriate parenting skills and disciplinary techniques, and parent and child communication skills.
Facilitates informal and formal community networks to build positive relationships and reduce social isolation.
Develops relationships with local community and military installation officials and organizations that can maximize program effectiveness.
Utilizes community-based services and formal and informal community networks to provide concrete support for families who may be in crisis.
Utilizes methods for screening for, assessing, and addressing protective and risk factors associated with child abuse and neglect using a strengths-based Family centered developmental approach.
Keeps tracking system up to date with case status.
Participates in monthly conference calls and annual training events.
Other Job Requirements
Responsibilities
Qualified candidates must have at least two (2) years of direct work experience in child abuse or domestic abuse, or maternal or child health or medical social work.
Must hold a current and active license as an LCSW, LMFT or RN.
Licensed Clinical Social Workers must possess a current, valid, unrestricted clinical license and a master's degree in Social Work to practice social work independently.
Registered Nurses must have at least a bachelor's degree in nursing, a current unrestricted license in one of the States or U.S. territories, and at least two (2) years of direct work experience with child abuse or domestic abuse, maternal or child health, public/community health, or mental health.
Must have home visitation experience.
Must have a valid driver's license, auto insurance and ability to operate a motor vehicle.
Must have working knowledge of basic computer skills and be able to use Microsoft Word, Power Point, and Excel programs.
Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices on most or all workdays.
Ability to communicate and interact with others, both in person and/or by telephone to conduct business.
Working under time pressure.
Working rapidly for long periods to meet deadlines.
Must be able to travel as needed and adhere to AFSC travel policies and procedures.
Must be able to enter private homes that may or may not provide easy access for those with physical disabilities or those recovering from physical rehabilitation or post-recovery mobility.
Position requires ability to transport self from office locations to private homes, other offices and facilities where training and other program activities occur.
General Job Information
Title
New Parent Support Program Child and Family Specialist, FASS
Grade
21
Work Experience - Required
Child Welfare
Work Experience - Preferred
Education - Required
Bachelors - Nursing, Masters - Counseling, Masters - Social Work
Education - Preferred
License and Certifications - Required
LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Serves as Lead ID card specialist and may operate as an autonomous service provider at a single-person site or as a Team Leader for sites with multiple ID card specialists. Provides professional military personnel support services to the U.S. Navy's Identification Card Administration (ICA) program at Navy installations designated as Defense Enrollment Eligibility Reporting System (DEERS) and Real-time Automated Personnel Identification System (RAPIDS) sites.
Serves as ID Card/Common Access Card (CAC) customer service specialist trained and certified by the Defense Manpower Data Center (DMDC).
Delivers ID Card services to all personnel assigned to support customer commands, other military service personnel, retirees and their dependents, and contractors verified through the Trusted Associate Sponsorship System (TASS).
Performs as a Verifying Official (VO) on DEERS/RAPIDS terminal and ensures inputted data for accuracy and correctness. Verifies the identity and eligibility of authorized DoD beneficiaries, issues DoD Identification Cards and performs DEERS updates in accordance with DoD regulations and AFI 36-3026.
Issues and strictly controls Armed Forces identification and privilege cards for all eligible personnel, (i.e., active duty military, retired military, 100% Disabled American Veteran (DAV) and respective dependents and verified contractors.
Operates and maintains RAPIDS workstations, processes CACs, assists customers with questions concerning identification card eligibility, application requirements and DEERS, and answers telephone inquiries.
Accomplishes DEERS enrollment and updates for all eligible beneficiaries, reconciles erroneous DEERS information, performs PIN resets, verifying and updating PKI certificates, and provides other ICA services as necessary.
May also be certified by DMDC as Site Security Manager (SSM) with responsibility for the safekeeping, storing, and accountability of the CAC and related consumable materials.
Maintains RAPIDS equipment within the physical parameters and configurations established at the time of installation. Performs -User Maintenance on RAPIDS equipment.
Other Job Requirements
Responsibilities
High School diploma or equivalent.
1+ years' experience in a Customer Service environment.
HR background in one of the following disciplines: Military Pay, Military Personnel, Travel Claims or Navy Transportation. Substitutions for HR background can be from similar experience gained in either the private sector or other Federal Agency.
Proficient in both oral and written communication to communicate effectively and explain complex actions regarding military entitlements, allowances and collections.
Working knowledge of Microsoft Office Products, i.e. Word, Excel, Power Point.
Working knowledge of standard office equipment such as computers, electric typewriters, copiers, fax machines, scanners and other office automation systems.
Must be U.S. citizen and possess favorably adjudicated Tier 3 (NACLC) security investigation.
General Job Information
Title
ID Card Specialist Lead (Personnel Assistant III)
Grade
WDNICAPAIII
Work Experience - Required
Customer Service
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
Researches, resolves and documents prior authorization outcomes in pharmacy system.
Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
Escalates requests to Pharmacist when request requires extensive clinical review or denial.
Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
Performs other duties as required.
Other Job Requirements
Responsibilities
Must have an active pharmacy technician licensure or registration in accordance with state requirements.
If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).
In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).
Active Pharmacist license supersedes requirement for CPT and/or PTCB.
Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
Excellent written and verbal communication skills.
Ability to follow clinical criteria and instructions to approve prior authorization requests.
Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
Ability to identify and trouble-shoot problematic issues.
General Job Information
Title
Clinical Pharmacy Technician I
Grade
17
Work Experience - Required
Pharmacy
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Care Manager, Behavioral Health - R00000051067 DESCRIPTION/RESPONSIBILITIES:For this position, it requires PA State behavioral health or RN licensure and must reside in the Newtown (Cambria Cty) area in PA. Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings. Collects and analyzes utilization data. Assists with discharge planning and care coordination. Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects.* Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.* Provides telephone triage, crisis intervention and emergency authorizations as assigned.* Performs concurrent reviews for inpatient and/or outpatient 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.* Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.* Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.* Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.* Participates in quality improvement activities, including data collection, tracking, and analysis.* Maintains an active work load in accordance with National Care Manager performance standards.* Works with community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria.* Participates in network development including identification and recruitment of quality providers as needed.* Advocates for the patient to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process. Other Job RequirementsLicensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements.One or more of the following licensure is required for this role with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC or RN.Minimum 2 years 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 outpatientsetting.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. General Job InformationTitleCare Manager, Behavioral Health Grade23 Work Experience - RequiredClinical Work Experience - Preferred Education - RequiredAssociates - Nursing, Bachelors - Social Work, Masters - Social Work Education - Preferred License and Certifications - RequiredCEAP - Certified Employee Assistance Professional - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt License and Certifications - Preferred Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and
This position is responsible for managing day-to-day operations for manufacturer invoicing and working directly with manufacturers to resolve any issues. Will remain up-to-date on current processes and concerns. Will be required to consistently meet established timeliness for service level agreements and quality objectives.
Maintains a clear understanding of rebate client contractual requirements, ensuring compliance with service level agreements.
Understands and adheres to departmental policies and procedures.
Processes quarterly manufacturer rebate invoicing for assigned clients or manufacturers.
Reviews invoicing practices, including pre-invoicing quality reviews and adjustments for fee for service, managed care, diabetic supply and supplemental rebate programs.
Produces reports, including federal rebate 64.9R.
Works directly with manufacturers pertaining to dispute resolution.
Acts as primary contact for manufacturers to answer/resolve rebate questions.
Conducts quality validation and approval of claim files.
Other Job Requirements
Responsibilities
2+ years of experience in customer support, analysis or business, preferably within a financial environment.
Associate's degree required or an additional 2 years of relevant experience in lieu of degree.
Strong verbal and written communication skills.
Strong working knowledge of Microsoft Word and Excel.
General Job Information
Title
Pharmacy Rebate Specialist, Government - Glen Allen, VA
Grade
19
Work Experience - Required
Customer Service, Operations
Work Experience - Preferred
Education - Required
A Combination of Education and Work Experience May Be Considered., Associates
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
CPT - Certified Pharmacy Technician - Pharmacy
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
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.
Other Job Requirements
Responsibilities
Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements.
Minimum of 6 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.
Licensure may also include one or more of the following: CEAP, LMSW, LCSW, LSW, LPC or RN.
CEAP certification as required by management.
Strong organizational, 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 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.
General Job Information
Title
Care Manager - Intermittent
Grade
24
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Associates - Nursing, Bachelors - Social Work, Masters - Behavioral Health, Masters - Counseling, Masters - Social Work
Education - Preferred
License and Certifications - Required
CEAP - Certified Employee Assistance Professional - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Under supervision, is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in office or to help offices locate a lower cost alternative treatment site (e.g., home infusion) for drug infusion services versus the hospital outpatient facility. Discusses financial and clinical considerations with members who are considering care at a higher cost treatment site, researches available financial programs to decrease members' out-of-pocket expense for drug services in office, and coordinates lower cost site of service for drug administration if provider is referring due to convenience factors (e.g., distance, non-typical infusing provider, etc.). Performs functions under supervision.
Provides site of service solutions to patients seeking care at non-preferred treatment sites (e.g., Hospital inpatient or outpatient facilities, non-par cancer treatment centers, etc.).
Discusses the financial aspect of the specialty drugs to both the member and the ordering physician (or office staff) and to agree to find a lower cost versus higher cost sites of service, coordinating drug infusion at an alternate lower cost treatment site and coordinating concomitant services to support infusion administration in lower cost sites.
Provides member with resources to optimize their treatment outcomes, by utilizing critical thinking skills and providing specific resources related to their complex illness.
Actions include supporting member copay-assistance programs, research and coordination to decrease member out of pocket financial responsibility in an office or home setting for drug services.
Will actively maintain a required case load and the activities to reach overall goals of switching site of service treatment to a lower cost setting while maintaining members' satisfaction during the process.
Documents and enters data of these cases in web-based application and spreadsheets.
Supports clinical services such as the appeals program.
Participates in meetings and consults with management on regular basis to discuss member interaction and program outcomes.
Maintains appropriate par levels of literature.
Familiarizes self with community resources available, benefit information or any other information that is valued with the program.
Maintains an active case load and accurate case records, adhering to all company policies and laws governing patient records including documentation of all daily activities.
Performs related duties as requested.
Clinical and Quality oversight for this program is provided by the Manager, Patient Programs.
Other Job Requirements
Responsibilities
Registered Nurse (RN).
5 years of post-degree clinical experience.
Experience in managed care, specialty drugs, care management and utilization review.
Meets Magellan Credentialing criteria.
At minimum must have current and active nursing license.
Ability to apply knowledge in relation to clinical findings from evidence based guidelines.
Ability to function independently and as a team member.
Good organizational, time management and communication skills.
Possesses the ability to achieve organizational goals through development of effective teams.
Comprehensive clinical knowledge of medical specialty drugs and the management of those drugs.
Understanding of the clinical aspect of the infusion of those drugs within various sites of service.
General Job Information
Title
Infusion Referral Nurse (REMOTE)
Grade
24
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Bachelors - Nursing
Education - Preferred
License and Certifications - Required
RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Plays a key role in medical and pharmacy management initiatives critical to the company achieving revenue goals and operational objectives. Responsible for executing specialty injectable utilization management programs on behalf of health plan/payor customers. Often the first point of contact that a providers office has when initiating an authorization for injectable or infused product. Requires communication and teamwork across all departments (Account Management, Specialty Pharmacy, IT, Project Management, Quality), as well as health plan/payor departments (medical management, pharmacy management) and an in-depth understanding of all specialty injectable therapeutic classes, products, trends, current management techniques and industry guidelines.
Provides outstanding customer service while also achieving department performance metrics.
In addition to the Utilization Management duties, this role serves as the UM/CS functional expert.
Uses expertise to aid others in issues which cannot be resolved or the amount of time involved in resolving the issue is anticipated to be excessive.
Provides assistance and coaching to other clinical pharmacy technicians when they require help in servicing a call.
Identifies individual clinical pharmacy technician training needs and work to address these needs. Act as a mentor to other clinical pharmacy technicians.
Assists in the monitoring and auditing staff calls to ensure accuracy and professionalism.
Assists the Supervisor in completing special projects as deemed necessary.
Other Job Requirements
Responsibilities
Must have an active pharmacy technician licensure or registration in accordance with state requirements.
If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).
In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).
Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
Excellent written and verbal communication skills.
Ability to follow clinical criteria and instructions to approve prior authorization requests.
Minimum of 2 years dispensing or retail experience required, or equivalent internal training will be substituted. 5+ years of experience in comparable role in a high-volume, multi-functional call center environment.
Ability to identify and trouble-shoot problematic issues.
For positions supporting Medicare Part B, requires 2+ years of experience in Medicare Part B.
General Job Information
Title
Lead Utilization Management Specialist-2
Grade
19
Work Experience - Required
Customer Service, Pharmacy
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
Associates - Pharmacy
License and Certifications - Required
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Responsible for the resolution of clinical appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical and administrative criteria and policies in line with regulatory and accreditation requirements for member and provider appeals and disputes. Independently coordinates the clinical resolution with internal and external clinician and medical management support as required. Documents and summarizes to all parties involved in the case investigation's results.
Communicates with medical office personnel to obtain pertinent clinical history and information. Documents and summarizes clinical or administrative rationale for all approvals and denials to all parties involved in the case.
Implements quality assurance plans for specific contracts and coordinates this activity with the appropriate account managers or dedicated quality assurance staff.
Interfaces with other departments to satisfactorily resolve issues related to appeals and retrospective reviews.
Participates in on-going training programs to ensure quality performance is in compliance with applicable standards and regulations.
Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures.
Provides optimum customer service through professional and accurate communication while maintaining accreditation and health plan's required timeframes.
Documents communications with medical office staff and/or MD provider as required.
Refers cases to appropriate internal reviewers according to the business needs of the particular health plan.
Researches requests for post-determination review and categorizes each for processing based on the applicable health plan policies and procedures.
Reviews and coordinates documentation; interprets data obtained from clinical records and ensures appropriate clinical criteria and policies are aligned with regulatory and accreditation requirements for members and providers.
Tracks all post-determination cases to completion to ensure compliance.
Trains new employees on the appeals and de-certification process as needed.
Works closely with the appeals-dedicated Clinical Reviewers to ensure timely adjudication of processed appeals.
Other Job Requirements
Responsibilities
Requires 1-3 years' experience and is a LPN.
Must be able to exercise independent and sound judgment in clinical decision making.
Must be computer literate and able to navigate through internal and external computer systems.
Strong organizational and effective time management skills; demonstrated ability to manage multiple priorities are a must.
Outstanding interpersonal and negotiation skills to effectively establish positive relationships both internally and externally.
Strong written and verbal communication skills.
General Job Information
Title
Appeals Nurse - Remote
Grade
24
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Associates - Nursing
Education - Preferred
License and Certifications - Required
LPN - Licensed Practical Nurse - Care Mgmt
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Primary function is to supervise the customer care staff responsible for responding to telephone inquiries from providers and members as they relate to eligibility, benefits, claims, and authorization of services. Supervises the staff in the implementation, servicing, and maintenance of accounts and account related activities.
Manages the customer care management (CMC) and supports services (if applicable) to ensure compliance with policies, procedures and customer requirements.
Measures performance and productivity against the standards.
Ensures the care center is meeting telephone access standards for Magellan.
Provides routine staff supervision activities regarding staffing, disciplinary actions and performance appraisals.
Interviews and screens applicants for positions within the department.
Monitors and evaluates data from the call tracking and call management telephone system for accuracy, completeness, inquiry response time and performance issues.
Ensures associates are given their QI scores, monthly report cards, and their productivity statistics individually.
Ensures motivational programs are being utilized.
Manage the department`s customer/support services quality improvement programs to ensure member and provider satisfaction.
Identifies training needs for the Customer Service Unit in developing specific training programs for the Service Center.
Responsible for the training and development of lower level staff and maintaining a teamwork environment.
Manages the complaint and grievance process.
Coordinates with sales account management and regional staff to provide smooth implementation of new business within the Care Center and Support Services.
Other Job Requirements
Responsibilities
Minimum 5 years' experience in a call center environment and 2 years' supervisory experience.
Must possess service excellence attitude.
Demonstrated track record of managing change with proven results.
Ability to identify individual and team developmental needs.
Ability to effectively coach and develop team members.
General Job Information
Title
Supervisor Customer Care
Grade
22
Work Experience - Required
Customer Service, Supervisory
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
Bachelors
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Provides Air Force (AF) personnel, their family members, or intimate partners who are victims of domestic abuse nonclinical emergent and urgent service through safety assessments and safety planning services. The Domestic Abuse Victim Advocate (DAVAs) promotes a coordinated community response to allegations of domestic abuse via providing a range of support and education services to victims during duty hours, as well as on-call emergency services after duty hours. This position provides comprehensive services 24 hours a day/7 days per week to assist and advocate for victims of domestic abuse and to ensure victims are connected with the appropriate resources to ensure their safety. The DAVA does not provide clinical treatment services.
Responds to calls IAW established protocols, maintains a record of calls, and provides the Family Advocacy Officer or designee a situational report the following duty day.
Partners with the Family Advocacy case manager, or mental health on-call provider if the treatment/case manager is unavailable, to establish current and effective safety plans. The victim's safety is the DAVA's top responsibility and priority. The DAVA shall review the Victim's Safety Plan during each victim contact. Establishes a Victim's Safety Plan on a case-by-case basis.
Develops safety plans based on initial and ongoing risk assessments. If imminent risk of serious harm or death is established, notify the FAO, law enforcement, and Command.
Includes children, if involved, in the process and evaluates physical safety and emotional well-being; refer involved children to the treatment/case manager for follow-on care.
Immediately reports any changes in the victim's circumstances that changes or impacts the safety plan to the FAP treatment/case manager or mental health on-call provider if the treatment/case manager is unavailable.
Determines victim's imminent risk of serious harm or death, risk factors will be assessed per the detailed job description.
Provides safety assessments and safety planning for comprehensive services to include emotional support, arrangement of transportation; accompany victims to medical, legal and/or law enforcement appointments, assist in securing protective orders, emergency food and/or shelter and information benefits.
Works directly with victims to ensure that expressed needs are advocated and presented to personnel at intervening agencies.
Assesses imminent risks for health and/ or safety of the victim and make referrals as appropriate.
Assists victims with navigating the system to obtain the services desired and refer victims to the appropriate services for continued care.
Ensures victims of domestic abuse receive sensitive, confidential with the exception of state, federal, and military reporting requirements and immediate comprehensive care and treatment needed to restore health and well-being.
Assists victims in developing safety plans, conduct a risk assessment, and provide emotional support, prevention awareness and education to victims.
Provides information on victim services and resources available on and/or off the installation.
Explains reporting options during the initial contact whenever possible to ensure that the victim makes informed decisions about whom to disclose information regarding the abuse.
Ensures that first responders, (Emergency Medical Services and or law enforcement etc.) when appropriate, are contacted immediately during emergencies and in situations where there is imminent harm to the victim or others.
Partners with the FAP treatment/case manager to support the victim and promote safety for the victim and children in the home. Briefs the treatment/case manager prior to the Clinical Case Staffing (CCS) so that the CCS team has the most current information on the victim and children for staffing.
Supports the Family Advocacy Outreach Manager (FAOM) in developing System Advocacy, Education and Public Awareness, and promoting a coordinated community response to domestic abuse.
Operates within established guidelines.
Other duties as assigned.
Other Job Requirements
Responsibilities
A Bachelor's degree from an accredited university in any of the following disciplines: Social Work; Psychology; Marriage, Family, and Child Counseling; Counseling or Behavioral Science; Criminal Justice, or related field.
Two years of experience assisting and providing advocacy services to victims of domestic abuse or sexual assault.
Upon hire, or within six-months of hiring, must obtain the Basic Advocate credential with designation of Comprehensive Intervention Specialist as approved and offered by the National Advocate Credentialing Program, which is overseen by the National Organization for Victims Assistance.
Before starting work, all FAP and DAVA personnel working with Military Treatment Facilities shall provide proof of immunization from the following diseases according to CDC guidelines: Hepatitis B, measles, mumps, rubella, varicella, and influenza, and proof of a negative TB skin test (completed within the past 12 months (if positive, proof of negative chest X-ray within the past 12 months).
At a minimum, all FAP and DAVA personnel working within a Military Treatment Facility must maintain current certification in either the American Heart Association Basic Life Support Course (BLS) (Course C) or the American Red Cross Cardiopulmonary Resuscitation (CPR)/BLS (Heart Saver) Course.
Shall be able to obtain and maintain a National Agency Check with Inquiries (NACI) Tier 1 Clearance.
Proficient in the use of Microsoft Office Suite and have the ability to input, retrieve, and format documentation via various database/software.
DAVAs shall have knowledge of military programs, organizations, chain of command, unit missions, life styles, and situations that contribute to family stress, problems and crisis situations.
Possess the ability to work effectively with individuals and families from diverse racial, ethnic, and socioeconomic backgrounds.
Ability to work cooperatively with military and civilian medical, social service, law enforcement, and legal personnel on behalf of victims.
Must possess and maintain a valid, unrestricted motor vehicle license.
Must possess transportation to transport victim in crisis (non-emergent) situations as a last resort.
Must be able to provide on-call 24 hours/7 days per week victim advocacy services.
Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices on most or all workdays.
Ability to communicate and interact with others, both in person and/or by telephone to conduct business.
Ability to work under time pressure. and rapidly for long periods to meet deadlines.
General Job Information
Title
Victim Advocate, AFMRA
Grade
WDNAFMRADAVA
Work Experience - Required
Victim Advocacy
Work Experience - Preferred
Education - Required
Bachelors - Behavioral Health
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
This position is a front-line service position providing assistance to Magellan's members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations is to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards.
Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
Assists in the mentoring and training of new staff.
Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.
Educates providers on how to submit claims and when/where to submit a treatment plan.
Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
Informs providers and members on Magellan's appeal process.
Leads or participates in activities as requested that help improve Care Center performance, excellence and culture.
Links or makes routine referrals and triage decisions not requiring clinical judgment.
Performs necessary follow-up tasks to ensure member or provider needs are completely met.
Provides information regarding Magellan's in-network and out-of-network reimbursement rates and states multiple networks to providers.
Refers callers requesting provider information to Provider Services regarding Magellan's professional provider selection criteria and application process.
Refers patients/EAP clients to the Magellan's Care Management team for a provider, EAP affiliate, or Facility.
Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
Support team members and participate in team activities to help build a high-performance team.
Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.
Other Job Requirements
Responsibilities
Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment.
Responsible for meeting call handling requirements and daily telephone standards as set forth by management.
Must agree to observing service for the purpose of training and quality control.
Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
Must be able to maneuver through various computer platforms while verifying information on all calls.
Must be able to talk and type simultaneously.
General Job Information
Title
Customer Care Associate I
Grade
16
Work Experience - Required
Customer Service
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
Associates, Bachelors
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Master Resilience Trainer - Performance Experts (MRT-PE) support government client's program at multiple locations. MRT-PEs teach mental skills, resilience and performance enhancement techniques to military Soldiers, Families and DA Civilians. Teaching is conducted in group and individual settings and includes general education in human performance along with personalized training on how to acquire and apply specific mental skills and techniques that cultivate the mental and emotional strength necessary to thrive in an environment of overwhelming demands and persistent conflict. The mental skills and techniques taught by the program include: Building Confidence, Goal Setting, Attention Control, Energy Management, Integrating Imagery and Team Building. Using these principles, MRT-PEs help the clients to become high performing -tactical athletes- and help foster high performing -unit teams- in preparation for, during, and following combat operations. Specifically, MRT-PEs teach performance psychology to further promote excellence and efficiency during physical, technical and tactical training, as well as during the challenges of combat operations. MRT-PEs also provide tailored education to facilitate Wounded Warriors in their transition back to their units or to civilian life. The program teams are comprised of 5-10 MRT-PEs and led by a seasoned Site Manager with prior military experience.
Attends training exercises and field operations as requested by individual units to serve as a performance enhancement consultant and to coach the clients and leaders on the acquisition of performance psychology techniques and their application to individual military tasks and unit operations.
Provides tailored educational programs and workshops to help Families and Civilians living and working in demanding environments achieve success and accomplish personal, professional and family goals.
Recommends improvements to all aspects of the program operations.
Performs routine program operational duties.
Conducts assessment, assists in program evaluation and supports research projects being conducted locally.
Assists or provides program overview briefings to VIPs and high-ranking leaders when required.
Develops and maintains professional development relating to all aspects of performance enhancement, academic proficiency and military-related knowledge.
Other Job Requirements
Responsibilities
Master's or Doctoral degree from an accredited college or university in the field of Psychology or Kinesiology with a specialized emphasis in sport and/or performance psychology.
Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices on most or all workdays.
Ability to communicate and interact with others, both in person and/or by telephone to conduct business.
Experience and ability to work under time pressure.
Working rapidly for long periods to meet deadlines.
Must be able to travel as needed and adhere to AFSC travel policies and procedures.
Must be able to enter private homes that may or may not provide easy access for those with physical disabilities or those recovering from physical rehabilitation or post-recovery mobility.
Position requires ability to transport self from office locations to private homes, other offices and facilities where training and other program activities occur.
Physical requirements can typically be characterized as active: Lifting, bending, sitting on the floor, climbing may be required in the position. Requires lifting or moving various pieces of equipment, maximum 40 lbs. Position may require work on hands and knees to conduct program activities.
Ability to manage multiple concurrent tasks and perform under stress.
Requires reading and comprehension proficiency.
Requires effective writing and problem solving skills.
Ability to maintain confidentiality.
Customer contact expertise.
Travel requirement: 25%.
General Job Information
Title
Master Resilience Trainer- Performance Expert, ARD-TS
Grade
22
Work Experience - Required
Work Experience - Preferred
Education - Required
Masters - Kinesiology, Masters - Psychology
Education - Preferred
PhD
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Master Resilience Trainer - Performance Experts (MRT-PE) support government client's program at multiple locations. MRT-PEs teach mental skills, resilience and performance enhancement techniques to military Soldiers, Families and DA Civilians. Teaching is conducted in group and individual settings and includes general education in human performance along with personalized training on how to acquire and apply specific mental skills and techniques that cultivate the mental and emotional strength necessary to thrive in an environment of overwhelming demands and persistent conflict. The mental skills and techniques taught by the program include: Building Confidence, Goal Setting, Attention Control, Energy Management, Integrating Imagery and Team Building. Using these principles, MRT-PEs help the clients to become high performing -tactical athletes- and help foster high performing -unit teams- in preparation for, during, and following combat operations. Specifically, MRT-PEs teach performance psychology to further promote excellence and efficiency during physical, technical and tactical training, as well as during the challenges of combat operations. MRT-PEs also provide tailored education to facilitate Wounded Warriors in their transition back to their units or to civilian life. The program teams are comprised of 5-10 MRT-PEs and led by a seasoned Site Manager with prior military experience.
Attends training exercises and field operations as requested by individual units to serve as a performance enhancement consultant and to coach the clients and leaders on the acquisition of performance psychology techniques and their application to individual military tasks and unit operations.
Provides tailored educational programs and workshops to help Families and Civilians living and working in demanding environments achieve success and accomplish personal, professional and family goals.
Recommends improvements to all aspects of the program operations.
Performs routine program operational duties.
Conducts assessment, assists in program evaluation and supports research projects being conducted locally.
Assists or provides program overview briefings to VIPs and high-ranking leaders when required.
Develops and maintains professional development relating to all aspects of performance enhancement, academic proficiency and military-related knowledge.
Other Job Requirements
Responsibilities
Master's or Doctoral degree from an accredited college or university in the field of Psychology or Kinesiology with a specialized emphasis in sport and/or performance psychology.
Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices on most or all workdays.
Ability to communicate and interact with others, both in person and/or by telephone to conduct business.
Experience and ability to work under time pressure.
Working rapidly for long periods to meet deadlines.
Must be able to travel as needed and adhere to AFSC travel policies and procedures.
Must be able to enter private homes that may or may not provide easy access for those with physical disabilities or those recovering from physical rehabilitation or post-recovery mobility.
Position requires ability to transport self from office locations to private homes, other offices and facilities where training and other program activities occur.
Physical requirements can typically be characterized as active: Lifting, bending, sitting on the floor, climbing may be required in the position. Requires lifting or moving various pieces of equipment, maximum 40 lbs. Position may require work on hands and knees to conduct program activities.
Ability to manage multiple concurrent tasks and perform under stress.
Requires reading and comprehension proficiency.
Requires effective writing and problem solving skills.
Ability to maintain confidentiality.
Customer contact expertise.
Travel requirement: 25%.
General Job Information
Title
Master Resilience Trainer-Performance Expert, ARD-TS
Grade
22
Work Experience - Required
Work Experience - Preferred
Education - Required
Masters - Kinesiology, Masters - Psychology
Education - Preferred
PhD
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.