Care Manager - Hollidaysburg, PA

This position is open to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. Experience working with the maternity population is preferred. The role is full-time and onsite in Hollidaysburg, PA.

About the role

Under general supervision and in collaboration with other members of the clinical team, you will authorize and review utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings. This role involves collecting and analyzing utilization data, assisting with discharge planning and care coordination, and providing member assistance with mental health and substance abuse issues. You will also participate in special quality improvement projects.

Responsibilities

• Monitor inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
• Provide telephone triage, crisis intervention, and emergency authorizations as assigned.
• Perform concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience.
• Develop discharge plans in conjunction with providers and facilities, and oversee their implementation.
• Perform quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.
• Provide 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.
• Interact with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.
• Participate in quality improvement activities, including data collection, tracking, and analysis.
• Maintain an active workload in accordance with National Care Manager performance standards.
• Work with community agencies as appropriate.
• Propose alternative plans of treatment when requests for services do not meet medical necessity criteria.
• Participate in network development, including identification and recruitment of quality providers as needed.
• Advocate for the patient to ensure treatment needs are met.
• Interact with providers in a professional, respectful manner that facilitates the treatment process.

Requirements

• Current license that meets State, Commonwealth, or customer-specific requirements (e.g., CEAP, LMSW, LCSW, LSW, LPC, or RN).
• Minimum of 2 years of 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 settings.
• Knowledge of DSM V or the most current diagnostic edition.
• Ability to analyze specific utilization problems, plan, and implement solutions that directly influence quality of care.

Qualifications

• Associate degree in Nursing, Bachelor's or Master's degree in Social Work.
• One or more of the following licensures with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC, or RN.

Pay

Salary range: $64,285 – $102,855. This information reflects the anticipated base salary range based on current national data. Minimums and maximums may vary by location. Actual pay will be adjusted based on skills, experience, education, and other job-related factors permitted by law. This position may also be eligible for short-term incentives.

Benefits

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