Care Manager, BH

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $64.3k - $102.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

👻 Ghost score 0%

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Magellan Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $101M Private Equity Round - Magellan Health Services on 2004-01

Healthcare • Healthcare Insurance

Magellan Health is a healthcare organization focused on behavioral health and care-management services. The company provides clinical care managers, military and family life counselors, and behavioral health services across regional programs (e. g. , Magellan Hawai‘i, Magellan of New Mexico), and supports treatment coordination for mental health and substance abuse conditions. It also offers programs that support military families and other institutional clients, indicating work in managed behavioral health and care coordination.

📋 Description

• Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient care settings • Collect and analyze utilization data • Assist with discharge planning and care coordination • Provide member assistance for mental health and substance abuse issues • Monitor levels of care to ensure medical necessity and effectiveness • Provide telephone triage, crisis intervention, and emergency authorizations • Perform concurrent reviews for inpatient, outpatient, and other applicable levels of care • Develop discharge plans with providers and facilities and oversee implementation • Perform quality clinical reviews and educate members and providers • Provide information about benefits, community resources, managed care programs, policies, procedures, and criteria • Consult Physician Advisors regarding clinical and authorization questions • Participate in quality improvement activities, including data collection, tracking, and analysis • Maintain workload according to National Care Manager performance standards • Work with community agencies and propose alternative treatment plans when services do not meet medical necessity criteria • Participate in network development and provider identification and recruitment • Advocate for patients and interact professionally with providers • Perform additional duties aligned with the role as assigned by a leader

🎯 Requirements

• Current license meeting State, Commonwealth, or customer-specific requirements • One or more required licenses: CEAP, LMSW, LCSW, LSW, LPC, or RN, with necessary degrees • Minimum 2 years of experience post degree in healthcare, behavioral health, psychiatric, and/or substance abuse health care setting • Strong organization, time management, and communication skills • Knowledge of utilization management procedures • Knowledge of mental health and substance abuse community resources and providers • Knowledge and experience in inpatient and/or outpatient settings • Knowledge of DSM V or most current diagnostic edition • Ability to analyze utilization problems and plan and implement solutions influencing quality of care • Required education options: Associate in Nursing, Bachelor's in Social Work, or Master's in Social Work • Security responsibilities and compliance with applicable legal, regulatory, contractual, and internal requirements

🏖️ Benefits

• Short-term incentives may be available • Comprehensive benefits package • Health, life, voluntary, and other benefits • Benefits and perks supporting physical, mental, emotional, and financial wellbeing • Tobacco-free workplace • Equal Opportunity Employer