Care Manager (UM/UR) - Remote, Idaho Licensed

Magellan Health; United States; Remote; USD 58,000 - 94,000; Full time

Job summary

An established industry player is seeking a dedicated Care Manager to join their clinical team. In this pivotal role, you will oversee the authorization and review of mental health and substance abuse services, ensuring quality care for members in both inpatient and outpatient settings. You will utilize your expertise to analyze utilization data, assist with discharge planning, and coordinate care while participating in quality improvement initiatives. This position offers the opportunity to make a meaningful impact on the lives of individuals seeking assistance, all within a supportive and dynamic work environment that prioritizes your professional growth and well-being.

Benefits

Comprehensive Benefits Package

Short-term Incentives

Health and Life Insurance

Voluntary Benefits

Qualifications

• Licensure required: CEAP, LMSW, LCSW, LSW, LPC, or RN.
• 2+ years experience in healthcare, behavioral health, or substance abuse.

Responsibilities

• Monitors mental health and substance abuse treatment services.
• Develops discharge plans and oversees their implementation.
• Participates in quality improvement activities and data analysis.

Skills

Organizational Skills

Time Management

Communication Skills

Utilization Management Procedures Knowledge

Problem Analysis

Education

Associate in Nursing

Bachelor's in Social Work

Master's in Social Work

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/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.

Responsibilities

• 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 oversees 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.
• 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 workload 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

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 (UM/UR) - Remote, Idaho Licensed
Grade: 24
Work Experience - Required: Clinical
Work Experience - Preferred: N/A
Education - Required: Associate - Nursing, Bachelor's - Social Work, Master's - Social Work
Education - Preferred: N/A
License and Certifications - Required: CEAP, LCSW, LMFT, LMSW, LPC, LSW, RN
License and Certifications - Preferred: N/A

Salary Range

Salary Minimum: $58,440
Salary Maximum: $93,500
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.