Sr Care Manager
Job Summary
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 QI projects. Manages a caseload of ICM members if assigned. May be assigned additional special responsibilities commensurate with experience and type of licensure. Will be expected to coach and mentor less experienced Care Managers.
Essential Functions:
- Monitor inpatient and intermediate level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
- Perform concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience. In conjunction with providers and facilities, develop discharge plans and oversee their implementation. Provide telephone triage, crisis intervention and emergency authorizations.
- Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Magellan Health Services policies and procedures, and criteria.
- Interact with Magellan Medical/Associate Director and/or Physician Advisors to discuss Clinical/authorization questions and concerns regarding specific cases.
- Participate in QI activities, including data collection, tracking, and analysis.
- Lead or participate in CMC activities as requested that help improve Care Center performance, excellence and culture. Support team members and participate in team activities to help build a high-performance team. Demonstrate flexibility in areas such as job duties and schedule in order to aid CMC in better serving its members and help Magellan achieve its business and operational goals. Assist CMC efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
- TRF’s to be reviewed by Master’s level Care Manager only. RN’s may perform all other related duties.
Minimum Requirements:
Education: Associate’s Degree/Nursing Diploma.
Field of study: RN, Master’s, or Doctoral Degree in a behavioral health related field.
Experience: 5-8 years.
Industry: Managed Care.
Job Specific: A minimum of 6 years post-degree experience in psychiatric and substance abuse health care for CMs with RN or Master’s degree.
A minimum of 3 years post degree experience for CMs with PhD experience to include utilization review or a minimum of 2 years Magellan CM experience with performance ratings of “meets expectations” or “exceeds expectations.”
Equivalent combination of experience and education is acceptable.
Computer Skills: Ability to use computer systems.
Licenses, Certifications, etc.: RN license at a minimum.
Meets Magellan credentialing requirements for independent professional practice if performing TRF reviews (Master’s level licensed behavioral health professional).
CEAP certification as required by management.
Other:
Good 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 setting.
Ability to function independently and as a team member.
Knowledge of DSM IV or most current diagnostic edition.
Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.
Preferred Qualifications:
Knowledge, Skills, Abilities: Good problem solving skills.
Excellent communication skills.
Independent.
Organized.
Self-starter.
