Job DescriptionThis position is responsible for the assessment, reassessment, care planning and coordination of care and services for Members enrolled in the case management program. Includes ongoing monitoring of an appropriate and effective person centered care plan, member education and care coordination. Regularly communicates with the member’s PCP and other providers, and integrates the member, caregiver and other provider feedback into the assessment and planning.
- Maintains a caseload of members enrolled in the case management program, including risk stratification of members, monitoring reassessment needs and facilitating transitions of care settings.
- Serves as the primary point of contact throughout the treatment episode at the levels of care.
- Coordinates with the interdisciplinary team of providers, vendors, facilities, discharge planners, nurses, social workers, care coordinators, and member/caregivers to effectively manage care plans and transitions of care settings.
- Maintains timely, complete and accurate documentation in compliance with regulatory policies and procedures.
- Participates in complex case rounds and/or meetings and consults with Physician Adviser/Medical Director on regular basis concerning the progress of members.
- Provides consultation to PCP/Providers as indicated with consent of client. Identifies barriers to accessing services and assists members as needed.
- Participate actively in the Quality Improvement program.
- Other duties as assigned.
General Job Information
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date3/15/2019
Date Requisition Created3/8/2019
EducationBachelors: Bachelors of Social Work (Inactive) (Required), Masters: Master of Science in Social Work (Inactive) (Required)
License and Certifications - RequiredCurrent licensure required for this position that meets State, Commonwealth or customer-specific requirements. - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - PreferredCCM - Certified Case Manager - Care Mgmt
Other Job Requirements
Minimum 3 years clinical experience with focus in managed care, including chronic pain management and medical/mental health issues associated with chronic pain.
Bachelors Degree in Nursing, Social Work or related Human Services Field. Masters degree in comparable fields of study preferred.
- Pain Management Certification (PMC) must be obtained within 2 years of hire date.
- Understands and is able to apply principals of Care Management and Person Centered Service Planning.
- Ability to apply Chronic Pain Management Program guidelines.
- Ability to understand and apply coverage guidelines and benefit limitations.
- Familiar with clinical needs and disease processes for chronic pain and co-occurring physical and behavioral illnesses.
- Understands and adapts appropriately to issues related to communication, cognitive or other barriers.
- Experience and ability to use Motivational Interviewing best practice approach.
- Ability to lead an interdisciplinary care team.
- Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner.
- Integrated medical and behavioral health experience preferred, including appropriate support services in the community and accessing alternative and complementary services, such as acupuncture, chiropractic, and therapeutic massage.
- Experience in utilization review, concurrent review and/or risk management a plus.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”