HMSA Care Manager BH, UM Reviewer - Remote Hawaii

Magellan Health; Hawaii; Remote; USD 118,000 - 178,000; Full time

Job summary

A leading company in healthcare seeks a Care Manager for mental health and substance abuse services in Hawaii. The role involves authorizing treatment, coordinating care, and improving service quality. Candidates must be licensed in Hawaii and have relevant healthcare experience.

Benefits

Medical insurance

Vision insurance

401(k)

Tuition assistance

Child care support

Qualifications

• Must be licensed and reside in Hawaii.
• Minimum 2 years experience in healthcare or behavioral health.

Responsibilities

• Authorizes and reviews utilization of mental health and substance abuse services.
• Develops discharge plans and oversees their implementation.
• Participates in quality improvement activities.

Skills

Organization

Time Management

Communication

Education

Associate - Nursing

Bachelor's - Social Work

Master's - Social Work

Job description

HMSA Care Manager BH, UM Reviewer - Remote Hawaii

Join to apply for the HMSA Care Manager BH, UM Reviewer - Remote Hawaii role at Magellan Health

HMSA Care Manager BH, UM Reviewer - Remote Hawaii

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Join to apply for the HMSA Care Manager BH, UM Reviewer - Remote Hawaii role at Magellan Health

This is a remote position in Hawaii, candidates must be licensed and reside in Hawaii.

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.

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, 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.

Work Experience - Required

Clinical

Education - Required

Associate - Nursing, Bachelor's - Social Work, Master's - Social Work

License and Certifications - One of the Following 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, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

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.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at Magellan Health by 2x

Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

Student loan assistance

Tuition assistance

Disability insurance

Child care support

Paid maternity leave

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