Care Manager - BH (Onsite, PA, Hollidaysburg)

About the role

This will be an in onsite full time position working Monday-Friday in the Blair County OMH office at 81 Holliday Hills Dr., Hollidaysburg, PA. This position is not available for remote work.

Responsibilities

• Authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings.
• Collects and analyzes utilization data.
• Aids in discharge planning and care coordination.
• Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects.
• Makes 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.
• 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, 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.

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 licensures 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.

Qualifications

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

Skills

• Utilization Management Procedures
• Mental Health and Substance Abuse Community Resources and Providers
• Inpatient and/or Outpatient Setting
• DSM V or Most Current Diagnostic Edition
• Analyze Specific Utilization Problems
• Plan and Implement Solutions

Benefits

Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Pay

Salary Minimum $64,285
Salary Maximum $102,855

Schedule

Full-time, Monday-Friday