Care Manager
Location: Baton Rouge Louisiana
Description: Magellan Health Services is hiring Care Manager right now, this vacancy will be placed in Louisiana. For detail informations about this vacancy opportunity please give attention to these descriptions. (
Job Number:
16312
)
Job Summary
Under the general supervision of the Manager Clinical Services, or Supervisor Care Management, and in collaboration with t! he other members of the clinical team, the incumbent authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care settings.
Collects and analyzes utilization data.
Under the direction of the supervisor or Medical Director, assists with discharge planning and ambulatory follow up activity.
Provides member assistance with mental health and substance abuse issues, and participates in special QI projects. Manage a caseload of ICM members if assigned.
Essential Functions:
Monitor inpatient and intermediate 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.
In conjunction with providers and facilities, develop discharge plans and oversee their implementation
Perform concurrent reviews ! for inpatient care and other levels of care as allowed by scop! e of practice and experience.
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 Physician Advisors to discuss Clinical/authorization questions and concerns regarding specific cases.
Participate in QI activities, including data collection, tracking, and analysis.
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 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.
Minimum Requirements:
Education: Associate’s Degree/Nursing Diploma:
RN, Master’s or Doctoral Degree in behavioral health related field.
Experience: 3 years experience post degree in psychiatric and/or substance abuse health care setting, including utilization review.
Associate Care Manager must have performance ratings of “meets expectations†or “exceeds expectations†in order to qualify for this position.
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).
Other:
Good organi! zation, 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.
Primary Location
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LA-Baton Rouge LA-BatonRouge1
Work Locations
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Baton Rouge (LA02)
Baton Rouge
Baton Rouge
708101796
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 breadth of our offerings, depth of expertise, clinical excellence and smart, 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 vacancy, please email us your resume, with salary requirements and a resume to Magellan Health Services.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Thu, 26 Sep 2013 18:52:02 GMT
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