Care Manager - BH

Company: Magellan Health Services ( Learn More )

General Information
US-MO-Maryland Heights
N/A
Not Specified
Full-Time
Not Specified
None
False
False
Job Description 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 inpatient 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.

ESSENTIAL FUNCTIONS:
Monitors inpatient and intermediate level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
Provides telephone triage, crisis intervention and emergency authorizations as assigned.
Performs concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience. In conjunction with providers and facilities, develops discharge plans and oversee their implementation.
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.

Minimum Requirements:
- Independent behavioral health licensure ( LPC, LCSW, LPC) or RN (psychiatric)
- Master's level or Associate for RN
- Two year's clinical work experience
- 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.

General Job Information

 

Title

Care Manager - BH

Grade

22

Job Family

Care Management

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

9/8/2017

Date Requisition Created

9/8/2017

Minimum Qualifications

Education

Associates: Nursing (Required), Bachelors: Social Work (Required), Masters: Social Work (Required)

License and Certifications - Required

CEAP - Certified Employee Assistance Professional - Care Mgmt, LCSW - Licensed Clinical Social Worker - 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

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.

Competencies

Language(s)

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

Job Requirements