• Magellan Health Services
  • Telecommuting/Work-At-Home
  • Full-Time

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Job Description

This position can be available for remote option and CA licensure required.
Preferred experience in Utilization Review.

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.
  • Minimum Qualifications

    Education

    Associates (Required), Masters (Required)

    License and Certifications - Required

    CEAP - Certified Employee Assistance Professional - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

    License and Certifications - Preferred

    Other Job Requirements

    Responsibilities

  • CA 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, LCSW, LPC, RN (with psychiatric)or LMFT.
  • 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 outpatientsetting.
  • 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.

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



    * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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