This position locates services for patients and members with the goal of supporting the coordination of care such that members are able to access care in a timely manner and to remain in the least restrictive level of care appropriate to their functioning. Facilitates continuity of care as patients move through levels of care as authorized by clinical staff. Responsible for problem-solving and explaining company programs and procedures to clients and providers. May be assigned additional special responsibilities commensurate with experience and qualifications, such as TRF (Treatment Request Form) review, CISD (Critical Incident Stress Debriefing) assistance, clinical decision follow up support or other clinical support as needed. Will coach and precept new hires and less experienced staff in all elements of the role responsibilities as detailed below.
Troubleshoots for the clinical team when an appropriate provider, type of service, or appropriate level of care cannot be readily found.
Links clients to appropriate services within the community.
Assists in discharge planning for hospitalized patients and makes appropriate placements as needed.
Participates in the treatment team and assists in coordinating physical, psychological and/or psychiatric services for the patients.
Provides information to members and providers regarding mental health, physical health and/or substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures.
Assists in the adhoc process either in submitting adhocs as the designated adhoc Care Worker or assisting Care Managers in completing the form correctly and, in utilizing search features for securing credentialed providers for appointments as needed.
Assists in monitoring the CW/Gatekeeping queue during the supervisor's absence.
Participates in quality activities, including data collection, tracking, and analysis.
Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies with possible suggestions for more effective processes.
Leads or participates in activities as requested that improve Care Center/Health Plan performance, excellence and culture.
Supports team members and participates in team activities that build a high-performance team.
Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help the company achieve its business and operational goals.
Demonstrates proficiency, ability and willingness to perform all responsibilities including but not limited to, Ambulatory Follow Up, Account Specific Follow Up, Community Resource Requests and basic file room procedures.
Assumes responsibility for self-development and career progression. Proactively seeks and participates in ongoing training (formal and informal) in all aspects of the role.
Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers and procedures.
Contributes to process improvements to enhance achievement of personal, team and company goals.
Other Job Requirements
Responsibilities
Understanding of plan benefit structures, psychiatric/medical terminology, and local communication resources
General Job Information
Title
Senior Care Worker
Grade
21
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
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.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here (https://www.magellanhealth.com/media/760295/mg-federal-contractors-applicant-english.pdf) .
Warning: Employment Scam
It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. -Interviews- are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office.
Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.
If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911
