Job DescriptionJOB DESCRIPTION
This position is available for Remote/work from home and requires VA State license.
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 residential and intermediate care settings. Collects and analyzes utilization data. Assists with discharge planning and ambulatory follow up activity. Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects.
Monitors residential and intermediate level of care services related to mental health, substance abuse treatment and EPSDT population to ensure medical necessity and effectiveness.
Provides telephone triage, crisis intervention and emergency authorizations as assigned. In conjunction with providers and facilities, develops discharge plans and oversee their implementation. Performs concurrent reviews for residential care and other levels of care as allowed by scope of practice and experience. 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/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.
VA State License: Behavioral Health Professional or RN (with psychiatric experience)
Education: Masters Degree/Nursing Diploma
Field(s) of study: RN, Masters, or Doctoral Degree in behavioral health related field
Industry: Managed Care
Job Specific: 3 years experience post degree in psychiatric and/ or substance abuse health care setting, including utilization review. Associate Care Manager must have performance ratings of “meets expectations” or “exceeds expectations” in order to qualify for this position.
Knowledge, Skills, Abilities:
Other: Good organization, time management and communication skills; knowledge of utilization management procedures, mental health, substance abuse, intellectual disabilities and Autism Spectrum Disorder 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.
Computer Skills: Ability to use computer systems
Licenses, Certifications, etc.: RN license at. a minimum. Meets Magellan credentialing requirements for independent professional practice (Masters level licensed behavioral health professional- LCSW, LPC, LMFT). CEAP certification as required by management.
This position as available as work from home.
General Job Information
TitleResidential Care Manager
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date10/29/2019
Date Requisition Created10/25/2019
EducationAssociates: Nursing (Required), Bachelors: Social Work (Required), Masters: Social Work (Required)
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
- 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: CEAP, LMSW, LCSW, LPC, RN or LPN.
- 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.
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.”