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Care Manager, Behavioral Health (UR, CM, EAP), CA licensed, Remote in CA

Company: Magellan Health
Location: San Diego
Posted on: September 12, 2021

Job Description:

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.

Utilization Review-
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: behavioral health/psychiatric.

Case Management-
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 (CoOE) Lead.
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 health/psychiatric.

  • 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.

Other Job Requirements

Responsibilities

  • Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements. 
  • 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 setting.
  • 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 and/or outpatient 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.

General Job Information

Title

Care Manager, Behavioral Health (UR, CM, EAP), CA licensed, Remote in CA

Grade

23

Work Experience

Clinical

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, 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

License and 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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