Care Manager, Behavioral Health (UR, CM, EAP), CA licensed, Remote in CA
Company: Magellan Health
Location: San Diego
Posted on: September 12, 2021
We are on an exciting journey to transform Magellan Behavioral
Health Clinical Operations and are currently recruiting for various
Care Manager opportunities for remote in California positions!
Seeking independent licensed behavioral health or RN professionals
with psychiatric/behavioral health experience.
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.
Requirements: CA independent behavioral health or RN licensure
(LCSW, LMFT, LPCC, or RN) with 2 years+ clinical experience:
This position is responsible for the assessment, reassessment, care
planning and coordination of care and services including ongoing
monitoring of an appropriate and effective person-centered care
plan, member education and care management. Conducts initial and
concurrent review for prior authorization of higher levels of care
against medical necessity criteria. Responsible for the development
of individualized care plans for high and moderate stratified
members in the Medicaid, Medicare, and Whole Health markets.
Possesses clinical knowledge, understands best practices and
continuous learning skills, review member records, and work in
conjunction with primary care, community benefits, and other
support opportunities to develop a long term care plan to guide the
member through their mental health care. Oversees the work of its
assigned care support team and work with non-licensed support staff
to meet standards of care and performance set by Member Market
Leads and the Care Management Center of Operational Excellence
Requirements: CA independent behavioral health or RN licensure
(LCSW, LMFT, LPCC, or RN), Education: Master’s BH or Bachelor’s/RN
with 5 years post degree experience in healthcare, behavioral
health, psychiatric and/or substance abuse health care setting.
EAP/Utilization Review, behavioral health-
Provides direct support to organizations and their employees
through the delivery of assessment, consultation, education and
triage services. Uses knowledge of federal regulations to assist
organizations in their appropriate handling of employee concerns
and problems. Consults with employees and organizations on variety
of workplace and work based issues. Provides clinical expertise in
order to restore employees with diminished performance to healthy
functioning. 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. CA independent behavioral health or RN licensure (LCSW,
LMFT, LPCC, or RN) with 2 years+ clinical experience: behavioral
- 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.
- 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: LCSW, LMFT, LPCC or RN.
- 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.
Care Manager, Behavioral Health (UR, CM, EAP), CA licensed, Remote
Associates: Nursing (Required), Bachelors: Social Work (Required),
Masters: Social Work (Required)
Certifications - Required
CEAP - 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, LSW - Licensed Social Worker - Care Mgmt, RN -
Registered Nurse, State and/or Compact State Licensure - Care Mgmt
Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity
Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the
security responsibilities and security controls unique to their
position; and comply with all applicable legal, regulatory, and
contractual requirements and internal policies and procedures.
Keywords: Magellan Health, San Diego , Care Manager, Behavioral Health (UR, CM, EAP), CA licensed, Remote in CA, Other , San Diego, California
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