Posted on Apr 8, 2019 by Magellan Health
- Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
- Provides telephone triage, crisis intervention and emergency authorizations as assigned.
- Performs concurrent reviews for inpatient and/or outpatient 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.
- Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.
- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
- Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.
- Participates in quality improvement activities, including data collection, tracking, and analysis.
- Maintains an active work load in accordance with National Care Manager performance standards.
- Works with community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria.
- Participates in network development including identification and recruitment of quality providers as needed.
- Advocates for the patient to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process.
General Job Information
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date3/21/2019
Date Requisition Created3/18/2019
EducationAssociates: Nursing (Required), Masters (Required)
License and Certifications - RequiredCEAP - Certified Employee Assistance Professional - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
Licensure is required for this position, specifically current license as a Registered Nurse (RN) or Masters or Doctoral-level behavioral health practitioner that meets State, Commonwealth or customer-specific requirements.
Licensure may also include one or more of the following: CEAP, RN, LPCC, LCSW or LMFT. Ability to meet Magellan credentialing requirements for independent professional practice IF performing TRF reviews (Masters level licensed behavioral health professional). Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community resources and providers.
Knowledge 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.Minimum 2 years experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care setting.
We are also seeking bilingual candidates that are fluent in the following languages:
Spanish, Vietnamese, Farsi, Korean, Arabic, and Chinese.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
Population Care Management