Care Manager (UMUR) Remote

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 andor 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 andor 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 andor 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.

• Other Job Requirements

  Responsibilities

  Licensure is required for this position, specifically a current license that meets State, Commonwealth or customerspecific requirements.
  One or more of the following licensure 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 andor 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 andor 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.

  General Job Information

  Title

  Care Manager (UMUR) Remote

  Grade

  24

  Work Experience Required

  Clinical

  Work Experience Preferred

  Education Required

  Associate Nursing, Bachelors Social Work, Masters Social Work

  Education Preferred

  License and Certifications Required

  CEAP Certified Employee Assistance Professional Care Mgmt, LCSW Licensed Clinical Social Worker Care Mgmt, LMFT Licensed Marital and Family Therapist Care Mgmt, LMSW Licensed Master Social Worker Care Mgmt, LPC Licensed Professional Counselor Care Mgmt, LSW Licensed Social Worker Care Mgmt, RN Registered Nurse, State andor Compact State Licensure Care Mgmt

  License and Certifications Preferred

  Salary Range

  Salary Minimum:

  $58,440

  Salary Maximum:

  $93,500

  This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individuals skills, experience, education, and other jobrelated factors permitted by law.

  This position may be eligible for shortterm incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

  Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobaccofree workplace. EOEMFVetDisabled.
  Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.