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.
