LTSS Clinical Review Manager
Richmond VA 23233
Job DescriptionResponsible for the management, direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care management staff, providing expertise in designated programs.
- Assists clinical management in the development and on-going management of designated staff.
- Performs care management review activities consistent with Magellan policies, procedures, and standards.
- Conducts recruitment, interviewing, and selection of properly qualified staff members and ensures appropriate orientation is provided.
- Regularly monitors the performance of care management staff. Monitors adherence to the efficiency goals for all staff including case volume, case closure rates, average handle time and other metrics.
- Supervises care management staff through approved audit processes including performing annual reviews and provides counseling and disciplinary action as necessary.
- Coordinates quality improvement activities under the direction of clinical management.
- Assists management in the development of strategic and operational goals and plans.
- Assists management in the identification and coordination of the necessary clinical and client service training needs.
- Analyzes specific utilization problems, plans and implements solutions that directly influence quality of care and cost efficiency.
- Supervises the collection of pertinent clinical information while maintaining a good rapport and relationship with providers.
General Job Information
TitleLTSS Clinical Review Manager
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date6/28/2019
Date Requisition Created6/28/2019
Work ExperienceClinical, Supervisory
EducationAssociates: Nursing (Required), Bachelors: Nursing, Masters: Behavioral Health (Required)
License and Certifications - RequiredBCBA - Board Certified Behavior Analyst - Care Mgmt, Current 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, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, PC - Professional Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
Minimum of 5 years of post clinical degree experience.
Minimum of 2 years of experience in utilization management (admissions, utilization review, and/or discharge planning).
Strong knowledge of Medicaid programs.
Knowledge of clinical decision making tools.
Strong clinical and assessment skills.
Outstanding verbal and written communication skills.
Ability to work independently and maintain flexibly in fast paced start up environment.
Ability to analyze data and use it to improve care delivery.
Self-starter with high level of accountability and responsibility for outcome of care.
Highly organized and able to manage multiple priorities appropriately.
Independent problem solving skills.
Able to work collaboratively and build enduring relationships with providers, members and the multidisciplinary team.
Working knowledge of Microsoft Office Product Suite.
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.”