Care Manager – UM/UR

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🔥 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

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 $101M Private Equity Round on 2004-01

Consulting • Insurance • Healthcare

Magellan Health is a leading healthcare management company that provides a range of services, including behavioral health, pharmacy management, and employee assistance programs. The company focuses on delivering high-quality care and support to individuals and families, particularly those in military and community settings. Magellan Health emphasizes personalized service and innovative solutions to improve health outcomes and enhance the overall patient experience.

📋 Description

• Authorize and review utilization of mental health and substance abuse services in inpatient and 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 levels of care within scope of practice and experience • Develop discharge plans with providers and facilities and oversee implementation • Perform quality clinical reviews, educate stakeholders, and make interventions to advance member care • Provide members and providers with information about benefits, community resources, managed care programs, policies, procedures, and criteria • Interact with Physician Advisors regarding clinical and authorization questions • Participate in quality improvement activities, including data collection, tracking, and analysis • Maintain an active workload according to National Care Manager performance standards • Work with community agencies • 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 is required • One or more required licensures: CEAP, LMSW, LCSW, LSW, LPC, or RN, with necessary degrees • State and/or Compact State Licensure required • Minimum 2 years of experience post degree in healthcare, behavioral health, psychiatric, and/or substance abuse healthcare settings • 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 implement solutions influencing quality of care

🏖️ Benefits

• Short-term incentives may be available • Comprehensive benefits package • Health, life, voluntary and other benefits • Physical, mental, emotional and financial wellbeing perks • Professional growth and development • Total health and wellness • Rewards and recognition • Employee unity • Tobacco-free workplace