Magellan Health is looking for a Care Manager, BH to join our team. In this role, you will work under general supervision and in collaboration with other clinical team members to authorize and review the utilization of mental health and substance abuse services in inpatient and outpatient settings. You will provide crisis intervention, assist members with treatment needs, and contribute to quality improvement projects.
What You'll Do
- Monitor inpatient and outpatient mental health and substance abuse services for medical necessity and effectiveness.
- Provide telephone triage, crisis intervention, and emergency authorizations as assigned.
- Perform concurrent reviews for inpatient and outpatient care.
- Develop and oversee the implementation of discharge plans with providers and facilities.
- Conduct quality clinical reviews, educating and intervening to advance member care.
- Inform members and providers about benefits, community resources, and program policies.
- Discuss clinical cases and authorization concerns with Physician Advisors.
- Participate in quality improvement activities, including data collection and analysis.
- Maintain an active workload in accordance with performance standards.
- Work with community agencies and identify and recruit quality providers for network development.
- Propose alternative treatment plans when requests do not meet medical necessity.
- Advocate to ensure patient treatment needs are met.
- Interact with providers in a professional, respectful manner.
What We're Looking For
- PA state licensure is required, specifically a current license that meets State, Commonwealth, or customer-specific requirements.
- One or more of the following licenses: CEAP, LMSW, LCSW, LSW, LPC, or RN.
- Minimum 2 years of post-degree experience in a healthcare, behavioral health, psychiatric, or substance abuse setting.
- Strong organization, time management, and communication skills.
- Knowledge of utilization management procedures and mental health/substance abuse community resources.
- Knowledge and experience in inpatient and/or outpatient settings.
- Knowledge of the DSM V or most current diagnostic edition.
- Ability to analyze utilization problems and implement solutions that influence quality of care.
Team & Environment
You will collaborate with other members of the clinical team to provide comprehensive care management.
Benefits & Compensation
- Compensation range: $58,440 - $93,500.
- May be eligible for short-term incentives.
- Comprehensive benefits package.
- Broad range of health, life, voluntary, and other benefits for physical, mental, emotional, and financial wellbeing.
Work Mode
This position is remote within Pennsylvania, specifically for candidates located in the Bedford and Somerset areas.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
