Maryland Heights MO 63043 St Louis 1 14100 Magellan Plaza
Job DescriptionUnder 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.
- Provides telephone triage, crisis intervention and EAP services
- 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
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date5/7/2019
Date Requisition Created5/3/2019
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 Mgmt
License and Certifications - Preferred
Other Job Requirements
Responsibilities- Good 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 setting.- Ability to function independently and as a team member.- 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.Minimum 3 years experience post degree in psychiatric and/or substance abuse health care setting, including utilization review.
- Licensure is required for this position, specifically current license as a Masters or Doctoral-level behavioral health practitioner that meets State, Commonwealth or customer-specific requirements. - Licensure may also include one or more of the following: LCSW, LMFT or LPC.- Ability to meet Magellan credentialing requirements for independent professional practice IF performing TRF reviews (Masters level licensed behavioral health professional).
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 position.
“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.”