Care Manager, BH - Remote PA

Magellan Health; Bethlehem (Northampton County); On-site; USD 64,000 - 103,000; Full time

Benefits offered by this job

Short-term incentives

Comprehensive benefits

Job summary

Magellan Health, Inc. seeks a licensed behavioral health professional for the remote PA Care Manager role.

You will authorize and review utilization of mental health and substance abuse services across inpatient and outpatient settings, collaborating with the clinical team to ensure medical necessity and quality care. Responsibilities include discharge planning, data analysis, crisis intervention, and provider communications.

Qualifications

• Licensure required (CEAP, LCSW, LMFT, LMSW, LPC, LSW, RN or state license).
• Minimum 2 years post-degree healthcare/behavioral health experience.
• Experience in inpatient/outpatient settings preferred.
• Knowledge of DSM V or current DSM edition.
• Strong organizational and communication skills.

Responsibilities

• Authorize and review utilization of mental health and substance abuse services.
• Collect and analyze utilization data.
• Discharge planning and care coordination.
• Provide member assistance and crisis intervention.
• Discharge plans with providers and oversee implementation.
• Quality improvement activities and data tracking.

Skills

Utilization management knowledge

Crisis intervention

Discharge planning

Communication skills

Data analysis

DSM V knowledge

Time management

Education

Associate - Nursing

Bachelor's - Social Work

Master's - Social Work

Job description

For this position, we are seeking PA licensed behavioral health professionals with experience working with children and adolescence, specifically, any experience with Intensive Behavioral Health Services levels of care, BHRS, and/or ABA would be preferable.

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/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.

• Monitors inpatient and/or outpatient 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 and/or outpatient 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.
• Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.
• 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.

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

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, LSW, LPC or RN.

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.

General Job Information

Title: Care Manager, BH - Remote PA

Grade: 25

Work Experience - Required: Clinical

Education - Required: Associate - Nursing, Bachelor's - Social Work, Master's - Social Work

License and Certifications - Required

CEAP - Certified Employee Assistance Professional - Care MgmtCare MgmtCare Mgmt, LCSW - Licensed Clinical Social Worker - Care MgmtCare MgmtCare Mgmt, LMFT - Licensed Marital and Family Therapist - Care MgmtCare MgmtCare Mgmt, LMSW - Licensed Master Social Worker - Care MgmtCare MgmtCare Mgmt, LPC - Licensed Professional Counselor - Care MgmtCare MgmtCare Mgmt, LSW - Licensed Social Worker - Care MgmtCare MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare MgmtCare Mgmt

Salary Range

Salary Minimum: $64,285

Salary Maximum: $102,855

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

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

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.