Lead Care Manager (Clinical CAT Assoc.)

San Diego CA 92108

Job Description

JOB SUMMARY
Provides support to Care Managers and other clinical team members through content knowledge, technical and UM expertise. Researches open questions and unresolved issues for CMs who are providing direct UM services. Mentors new Care Manager hires and assists with training.

Essential Functions

br>Provide point of need support and coaching to Care Managers and other clinical team members in the course of normal operations. Build clinical team members expertise through direct feedback and real-time coaching. Be available to provide clinical, procedural or interpretational assistance.
Mentor and train Care Managers. Serve as a “buddy” to new Care Managers during their first months on the job by providing daily support and feedback.
Research and resolution of escalated issues that frontline CMs cannot resolve in a timely way. As necessary, take escalated calls or fill-in for CM team during high-peak periods.
Work with the Operations Hub team to Perform data collection and analysis of trends to determine problem areas and strategies for better practices for CM team.

NON-

Essential Functions

br>Maintain an active workload in accordance with Care Manager performance standards. Provide frontline functions during high volume and peak periods. Advocate for the patient to ensure treatment needs are met. Interact with providers in a professional, respectful manner that facilitates the treatment process.

MINIMUM REQUIREMENTS
Education: BA/BS
Experience: 5-8yrs.
Industry: Managed care
Job Specific: A minimum of six (6) years post-degree experience in psychiatric and substance abuse health care for CMs with RN or Master’s degree. A minimum of three (3) years post degree experience for CMs with Ph.D. Experience to include utilization review.
Equivalent combination of experience and education is acceptable.
Other: Experience and/or training in the functional areas as defined by the specific position within the unit (i.e. inpatient experience if the position will involve inpatient concurrent reviews); knowledge of managed care, mental health and substance abuse community resources and providers; good verbal/people skills; ability to function independently and as a team member; good organization, time management and communication skills. Familiarity with DSM IV or most current diagnostic edition.
Computer Skills: Facility with computers
Licenses, Certifications, etc.: RN license at a minimum. Meets Magellan credentialing requirements for independent professional practice IF reviewing TRFs.

JOB SUMMARY

Provides support to Care Managers and other clinical team members through content knowledge, technical and UM expertise.  Researches open questions and unresolved issues for CMs who are providing direct UM services.   Mentors new Care Manager hires and assists with training.

Essential Functions

/p>

Provide point of need support and coaching to Care Managers and other clinical team members in the course of normal operations.  Build clinical team members expertise through direct feedback and real-time coaching.  Be available to provide clinical, procedural or interpretational assistance.

Mentor and train Care Managers.  Serve as a “buddy” to new Care Managers during their first months on the job by providing daily support and feedback.

Research and resolution of escalated issues that frontline CMs cannot resolve in a timely way.  As necessary, take escalated calls or fill-in for CM team during high-peak periods.

Work with the Operations Hub team to Perform data collection and analysis of trends to determine problem areas and strategies for better practices for CM team.

NON-

Essential Functions

/p>

Maintain an active workload in accordance with Care Manager performance standards.  Provide frontline functions during high volume and peak periods.  Advocate for the patient to ensure treatment needs are met.  Interact with providers in a professional, respectful manner that facilitates the treatment process.

MINIMUM REQUIREMENTS

Education:  BA/BS

Experience:  5-8yrs.        

Industry: Managed care

Job Specific: A minimum of six (6) years post-degree experience in psychiatric and substance abuse health care for CMs with RN or Master’s degree.  A minimum of three (3) years post degree experience for CMs with Ph.D.  Experience to include utilization review.

Equivalent combination of experience and education is acceptable.

Other: Experience and/or training in the functional areas as defined by the specific position within the unit (i.e. inpatient experience if the position will involve inpatient concurrent reviews); knowledge of managed care, mental health and substance abuse community resources and providers; good verbal/people skills; ability to function independently and as a team member; good organization, time management and communication skills.  Familiarity with DSM IV or most current diagnostic edition.

Computer Skills: Facility with computers

Licenses, Certifications, etc.: RN license at a minimum.  Meets Magellan credentialing requirements for independent professional practice IF reviewing TRFs.

General Job Information

Title

Lead Care Manager (Clinical CAT Assoc.)

Grade

25

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

9/12/2019

Date Requisition Created

9/12/2019

Work Experience

Clinical

Education

Associates: Nursing (Required), Masters: Behavioral Health (Required), Masters: Counseling (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, LPN - Licensed Practical Nurse - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements.
  • Minimum of 6 years post-degree experience in psychiatric and substance abuse health care.
  • Minimum of 3 years post degree experience for Care Managers with Ph.D. Experience to include utilization review.
  • Licensure may also include one or more of the following: CEAP, LMSW, LCSW, LPC or LPN. CEAP certification as required by management.
  • 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 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.

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.”