Magellan HRSC, Inc.
Care Manager (Personal Services)
ESSENTIAL FUNCTIONS:
- 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, may develop discharge plans and oversee their implementation. May also perform 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
Title
Care ManagerGrade
22Job Family
Care ManagementCountry
United States of AmericaFLSA Status
United States of America (Exempt)Recruiting Start Date
4/23/2018Date Requisition Created
4/23/2018Minimum Qualifications
Education
Associates: Nursing (Required), Bachelors: Social Work (Required), Masters: Social Work (Required)License and Certifications - Required
CEAP - 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 MgmtLicense and Certifications - Preferred
Other Job Requirements
Responsibilities
- Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements.Competencies
Language(s)
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled