Magellan Health

Compensation

Full Description

Description: • Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient settings • Collect and analyze utilization data and perform concurrent reviews for inpatient/outpatient care • Assist with discharge planning, develop discharge plans with providers and oversee implementation • Provide telephone triage, crisis intervention and emergency authorizations as assigned • Perform quality clinical reviews, educate and intervene to advance member care • Provide information to members and providers about benefits, community resources, managed care programs, policies and criteria • Interact with Physician Advisors on clinical and authorization questions • Participate in quality improvement activities including data collection, tracking, and analysis • Maintain active workload according to National Care Manager performance standards • Participate in network development, provider recruitment, and advocate for patient treatment needs Requirements: • Licensure required: CEAP, LMSW, LCSW, LSW, LPC or RN (must meet State, Commonwealth or customer-specific requirements) • Associate degree in Nursing or Bachelor's/Master's in Social Work (education required/preferred as listed) • Minimum 2 years post-degree experience in healthcare, behavioral health, psychiatric and/or substance abuse settings • Strong organization, time management and communication skills • Knowledge of utilization management procedures and mental health and substance abuse community resources and providers • Knowledge and experience in inpatient and/or outpatient settings • Knowledge of DSM V or most current diagnostic edition • Ability to analyze utilization problems, plan and implement solutions to influence quality of care Benefits: • May be eligible for short-term incentives • Comprehensive benefits package • Broad range of health, life, voluntary and other benefits and perks • Programs that enhance physical, mental, emotional and financial wellbeing • Professional growth, development, rewards and recognition