Care Manager, UM/UR

🔥 0 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $64.3k - $102.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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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 inpatient and outpatient mental health and substance abuse services • Collect and analyze utilization data • Assist with discharge planning and care coordination • Provide member assistance for mental health and substance abuse issues • Participate in quality improvement projects • Monitor levels of care to ensure medical necessity and effectiveness • Provide telephone triage, crisis intervention, and emergency authorizations • Perform concurrent reviews for inpatient and outpatient 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 • Interact with Physician Advisors regarding clinical and authorization questions • 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, including identifying and recruiting quality providers • Advocate for patients and facilitate the treatment process with providers

🎯 Requirements

• Current licensure 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 healthcare settings • Idaho licensure required; candidates residing outside Idaho must also be licensed in their state of residence • 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 the 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

🏖️ 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