Care Manager - BH
Company: Magellan Health
Location: San Diego
Posted on: November 17, 2019
Under general supervision, and in collaboration with other members
of the clinical team, authorizes and reviews utilization of mental
health and substance abuse services provided in inpatient and/or
outpatient care settings. Collects and analyzes utilization data.
Assists with discharge planning and care coordination. Provides
member assistance with mental health and substance abuse issues,
and participates in special quality improvement projects.
- 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
- 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
- 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 InformationTitleCare
Manager - BHGrade23Job FamilyClinical Services GroupCountryUnited
States of AmericaFLSA StatusUnited States of America
(Exempt)Recruiting Start Date10/18/2019Date Requisition
Created10/16/2019Work ExperienceClinicalEducationMasters: Social
Work (Required)License and Certifications - RequiredCEAP -
Certified Employee Assistance Professional - Care Mgmt, LCSW -
Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed
Marital and Family Therapist - 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 - PreferredOther Job
- CA Licensure is required for this position, specifically a
current license that meets State, Commonwealth or customer-specific
- One or more of the following licensure is required for this
role with necessary degrees:-- CEAP, LPCC, --LMFT, or LCSW.
- Minimum 2 years experience post degree in healthcare,
behavioral health, psychiatric and/or substance abuse health care
- Strong organization, time management and communication
- Knowledge of utilization management procedures, mental health
and substance abuse community resources and providers.
- Knowledge and experience in inpatient and/or
- 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.Magellan Health Services is proud to be an Equal Opportunity
Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every
employee must understand, comply and attest to the security
responsibilities and security controls unique to their
Keywords: Magellan Health, San Diego , Care Manager - BH, Executive , San Diego, California
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