Care Manager II- Union
Location: Michigan
Description: Magellan Health Services is looking of Care Manager II- Union right now, this job will be placed in Michigan. For complete informations about this job opportunity kindly read the description below. (
Job Number:
15168
)
Job Summary
Authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care se! ttings; 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 inform! ation to members and providers regarding mental health and sub! stance 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.
Non-essential Functions
Maintain an active work load in accordance with 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; Assist network by identifying gaps in the network and quality providers.
Advocate for the patient to ensure treatment needs are met.
Interact with providers in a professional, respectful manner that facilitates the treatment process.
Minimum Requirements
Education:
Associates Degree/Nursing Diploma
Field(s) of study: RN, Masters, or Doctoral Degree in behavioral health related field
Experience:
5-8yrs.
Industry: Manage! d Care
Job Specific: A minimum of six (6) years post -d! egree experience in psychiatric and substance abuse health care for CMs with RN or Master’s degree.
A minimum of three (3) years post
degree experience for CMs with Ph.D. Experience to include utilization review, or a minimum of two (2) years Magellan CM experience with performance ratings of “meets expectations†or
“exceed expectationsâ€.
Will accept an equivalent combination of experience and education.
Knowledge, Skills, Abilities:
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. !
Computer Skills: Ability to use computer systems
Licenses, Certifications, etc.: RN licence at. a minimum.
Meets Magellan credentialing
requirements for independent professional practice IF performing TRF reviews (Masters level licensed behavioral health professional.
Primary Location
-
MI-FarmingtonHillsMI-34705WTwelveMileRoad
Work Locations
-
34705 W Twelve Mile Road (MI04)
34705 W Twelve Mile Road
Suite 148
Farmington Hills
Magellan Health Services is a leading specialty health care management organization with expertise in managing behavioral health, radiology and specialty pharmaceuticals, as well as public sector pharmacy benefits programs. We deliver innovative solutions to make a positive impact on the cost and quality of health care, keeping the best interests of the people we serve at the center of our decision-making. The bre! adth of our offerings, depth of expertise, clinical excellence and smar! t, talented employees is what makes us unique.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment where we value professional growth and development, total health and wellness, rewards and recognition and employee unity. Magellan is a place where you can thrive.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Magellan Health Services.
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This job starts available on: Thu, 04 Apr 2013 15:04:59 GMT