Magellan Health

Business Operations

• Serve as a critical liaison between Non-Clinical Operations, Finance, and Analytics
• Lead and support cross-functional business operations, continuous process improvement, and quality improvement initiatives
• Build analyses and reports using persuasive data visualization and communicate complex analytic findings to varied audiences
• Plan, direct, and measure large-scale cross-departmental projects and day-to-day performance metrics
• Provide technical and reporting expertise and process improvement consultation
• Work with leadership and the executive team to measure and analyze program and project performance
• Support project leads in defining business processes, data availability, requirements, and operational procedures
• Conduct trend analysis and assist with implementing financially and operationally focused recommendations
• Collect, analyze, and interpret qualitative and quantitative data, including preliminary analytical and root cause analyses
• Support exploratory data analysis and aggregation from authorization, claims, phone system, and HR data sources
• Capture workflows and operational processes with subject matter experts to support operational effectiveness and efficiency
• Document, support development activities, and roll out operational performance analyses using various computing tools
• Create analytic views to help management interpret historical operational performance
• Partner with Workforce Management to create and adapt flexible operations staffing models
• Perform ad hoc analyses of varying duration and complexity
• Support user-friendly tools for measuring, managing, and reporting customer experience management effectiveness
• Document operational performance metrics and participate in defining study issues and methodologies
• Analyze processes and workflows to improve key metrics and present findings in understandable formats
• Communicate timely regarding deliverables
• Collaborate across the organization to maximize efficiency and effectiveness
• Help create user acceptance test scripts and test plans
• Assist with training, communications, presentations, and project documentation

Business Operations Analyst

Manager

• Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient care settings
• Collect and analyze utilization data
• Assist with discharge planning and care coordination
• Provide member assistance with mental health and substance abuse issues
• Participate in special quality improvement projects
• Monitor levels of care to ensure medical necessity and effectiveness
• Provide telephone triage, crisis intervention, and emergency authorizations
• Perform concurrent reviews for inpatient and/or outpatient care and other levels of care within scope of practice and experience
• Develop discharge plans with providers and facilities and oversee implementation
• Perform quality clinical reviews and educate members and providers
• Provide information about benefits, community treatment resources, managed care programs, policies, procedures, and criteria
• Interact with Physician Advisors regarding clinical and authorization questions
• Participate in quality improvement activities, including data collection, tracking, and analysis
• Maintain workload according to National Care Manager performance standards
• Work with community agencies and propose alternative treatment plans when services do not meet medical necessity criteria
• Participate in network development, including identifying and recruiting quality providers
• Advocate for patients and interact professionally with providers

Care Manager, BH – Louisiana License Required

• Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient care settings
• Collect and analyze utilization data
• Assist with discharge planning and care coordination
• Provide member assistance for mental health and substance abuse issues
• Participate in quality improvement projects and activities
• Monitor inpatient and/or outpatient levels of care for medical necessity and effectiveness
• Provide telephone triage, crisis intervention and emergency authorizations
• Perform concurrent reviews for inpatient/outpatient care and other levels of care within scope of practice and experience
• Develop discharge plans with providers and facilities and oversee implementation
• Perform quality clinical reviews and educate members and providers
• Provide information about benefits, community resources, managed care programs, policies, procedures and criteria
• Discuss clinical and authorization questions with Physician Advisors
• Maintain workload according to National Care Manager performance standards
• Work with community agencies
• Propose alternative treatment plans when services do not meet medical necessity criteria
• Participate in network development, including identifying and recruiting quality providers
• Advocate for patients and interact professionally with providers

Counselor

• Provide the full breadth of Military and Family Life Counselor consultation and counseling services to military commands, service members, and their families
• Provide non-medical, short-term, solution-focused, walk-around counseling at assigned primary and secondary locations
• Conduct assessments, brief counseling, consultation, action planning, referrals, resource linkage, and follow-up
• Deliver training and health and wellness presentations
• Participate in health fairs and other base or installation activities
• Enter counselor activity data daily through smartphone or web application while maintaining confidentiality
• Maintain visibility within assigned brigades/regiments to ensure services are accessible
• Establish working relationships with community resources and provide appropriate linkages
• Partner with installation Points of Contact to address installation needs
• Respond to critical incidents, surge and on-demand events, and special requests
• Flex schedule to respond to urgent requests
• Manage duty-to-warn and restricted-reporting situations according to Department of Defense protocol
• Communicate with Regional Supervisors and participate in individual and group supervision
• Share information regarding installation trends and issues
• Participate in in-service training, Quality Improvement committees, and other contract activities
• Participate in initiatives, studies, and pilot programs, including certification, training, documentation, and technology use
• Perform other duties as assigned

Military and Family Life Counselor – Adults or Children

• Provide coverage in short-term, surge, and on-demand situations for military-related needs
• Provide Adult or Child and Youth Behavioral (CYB) non-medical counseling services to military service members and their families
• Provide assessment, brief counseling, consultation, action planning, referrals, resource linkage, and follow-up
• Deliver training and health and wellness presentations
• Consult with parents, child daycare centers, schools, youth programs, and installation command on behavioral health issues
• Support CDCs, DoDEA and community schools, youth programs, summer camps, military community and readiness centers, and on-demand assignments
• Work closely with installation and military branch Points of Contact to ensure services remain within scope and meet installation needs
• Participate in health fairs and other base or installation activities
• Enter counselor activity data daily through a smartphone or web application while maintaining confidentiality and anonymity
• Establish a confidential, approachable presence on installations and in child and youth settings
• Establish and maintain relationships with community resources and provide appropriate linkages
• Manage duty-to-warn and restricted-reporting situations according to DoD protocol
• Communicate with Regional Supervisors and participate in individual and group supervision
• Respond to critical incidents and special requests as directed by the Point of Contact and approved by the OSD program manager

Military and Family Life Counselor – Short Term Assignments

• Provide the full breadth of Child and Youth Behavioral counseling services to military children and families at military and off-installation locations
• Deliver non-medical, short-term, solution-focused counseling, including assessment, brief counseling, consultation, action planning, referrals and follow-up
• Provide consultation to parents, personnel, schools and installation command regarding behavioral health issues affecting children and youth
• Support DoDEA and community school staff and personnel, summer camps and youth programs
• Provide parent training and guidance
• Deliver training and health and wellness presentations; participate in health fairs and installation activities
• Enter counselor activity data daily through smartphone or web application while maintaining confidentiality and anonymity
• Establish relationships with community resources and provide appropriate linkages
• Maintain visibility in schools and follow line-of-sight protocol
• Partner with installation Points of Contact to address facility needs and maintain professional working relationships
• Manage duty-to-warn and restricted-reporting situations according to DoD protocol
• Participate in regular individual and group supervision
• Respond to critical incidents and special requests as directed
• Flex schedule for urgent requests when needed
• Participate in in-services, training, Quality Improvement committees, initiatives, studies, pilot programs and other contract activities
• Complete documentation and use applicable technology for required activities
• Perform other duties as assigned

Military and Family Life Counselor

• Provide personal financial services at assigned military installations
• Provide personal financial counseling and management services directly to service members and their families
• Conduct one-on-one counseling and consultations with commanders, providers, and staff
• Conduct briefings and presentations
• Provide referral resources outside counseling sessions
• Work with installation and military branch Points of Contact to ensure program scope and installation needs are met
• Assist service members in establishing spending plans for extended absences
• Develop and provide informational financial materials
• Coordinate, publicize, and provide Personal Financial Management classes and workshops across the military lifecycle
• Respond to requests for age-appropriate classes and seminars
• Provide virtual counseling and electronic communications when authorized
• Manage duty-to-warn situations according to Department of Defense protocol
• Communicate with leadership and participate in individual and group supervision
• Share information about installation trends and issues
• Participate in in-service training, quality improvement committees, and other contract activities
• Perform other assigned duties

Personal Financial Counselor

• Provide coverage in short-term, surge, and on-demand situations for military needs
• Cover post-deployment events and assignments for absent counselors
• Provide Adult or Child and Youth Behavioral counseling services at military installations
• Deliver non-medical, short-term, solution-focused counseling to service members and their families
• Conduct assessments, brief counseling, consultation, action planning, referrals, resource linkage, and follow-up
• Provide training and health and wellness presentations
• Participate in health fairs and other base or installation activities
• Consult with parents, child daycare centers, schools, youth programs, and installation command on behavioral health issues
• Support CDCs, DoDEA and community schools, youth programs, and summer camps
• Work with installation and military branch Points of Contact to meet installation needs
• Enter counselor activity data daily via smartphone or web application while maintaining confidentiality and anonymity
• Establish relationships with community resources and provide appropriate linkages
• Manage duty-to-warn and restricted-reporting situations according to DoD protocol
• Participate in individual and group supervision and communicate trends and issues to Regional Supervisors
• Respond to critical incidents and special requests as directed

Military and Family Life Counselor – Short Term Assignments, On Demand

• Provide the full breadth of Child and Youth Behavioral counseling services to children of military service members and their families
• Provide non-medical, short-term, solution-focused counseling at assigned primary and secondary locations
• Conduct assessments, brief counseling, consultation, action planning, referrals, resource linkage, and follow-up
• Provide consultation to parents, military personnel, schools, and installation command on behavioral health issues
• Support DoDEA and community school staff and personnel, youth programs, and summer camps
• Provide parent training and guidance
• Deliver training and health and wellness presentations
• Participate in health fairs and other installation activities focused on children and youth
• Enter counselor activity data daily through smartphone or web application while maintaining confidentiality and anonymity
• Establish relationships with community resources and provide appropriate linkages
• Maintain visibility within schools and follow line-of-sight protocol
• Partner with installation/facility Points of Contact to deliver CYB services
• Manage duty-to-warn and restricted-reporting situations according to DoD protocol
• Communicate with Regional Supervisors and participate in individual and group supervision
• Respond to critical incidents and special requests
• Flex schedule for urgent requests as needed
• Participate in in-services, training, Quality Improvement committees, initiatives, studies, pilot programs, and other contract activities
• Complete activity documentation and use applicable technology for required activities
• Perform other duties as assigned

• Provide comprehensive Child and Youth Behavioral counseling services to children of military service members and their families
• Deliver non-medical, short-term, solution-focused counseling, assessment, brief counseling, consultation, action planning, referrals, and follow-up
• Support staff and personnel at child development centers, youth programs, and summer camps
• Provide parent support, training, and guidance
• Deliver training and health and wellness presentations and participate in health fairs and installation activities
• Enter counselor activity data daily using a smartphone or web application while maintaining confidentiality and anonymity
• Establish relationships with community resources and provide appropriate linkages
• Maintain visibility and accessibility at assigned locations while following line-of-sight protocols
• Partner with installation Points of Contact to address facility needs and maintain professional working relationships
• Manage duty-to-warn and restricted-reporting situations according to DoD protocol
• Participate in individual and group supervision and communicate installation trends and issues to Regional Supervisors
• Respond to critical incidents and special requests, including flexing the schedule as needed
• Participate in training, Quality Improvement committees, initiatives, studies, pilot programs, certification processes, and other contract activities
• Complete documentation and use applicable technology for required activities
• Perform other assigned duties

Military and Family Life Counselor – Child and Youth Behavioral and School

• Provide the full breadth of Child and Youth Behavioral counseling services to children of military service members and their families
• Provide non-medical, short-term, solution-focused counseling at assigned primary and secondary locations
• Conduct assessments, brief counseling, consultation, action planning, referrals, resource linkage, and follow-up
• Support DoDEA and community school staff and personnel, youth programs, and summer camps
• Provide parent training and guidance
• Deliver training and health and wellness presentations
• Participate in health fairs and other installation activities focused on children and youth
• Enter counselor activity data daily through a smartphone or web application while maintaining confidentiality and anonymity
• Establish and maintain relationships with community resources and provide appropriate linkages
• Maintain visibility within schools and follow line-of-sight protocol
• Partner with installation/facility Points of Contact to address local needs
• Manage duty-to-warn and restricted-reporting situations according to DoD protocol
• Participate in individual and group supervision with the Regional Supervisor
• Respond to critical incidents and special requests as directed
• Flex schedule for urgent requests when needed
• Participate in in-services, training, Quality Improvement committees, initiatives, studies, pilot programs, and other contract activities
• Complete activity documentation and use applicable technology for required activities
• Perform other duties as assigned

Military and Family Life Counselor, Adult and Child Development Center

Full-stack Engineer

• Create and update maps, guidelines, and profiles using Edifecs tools including EDIFECS SpecBuilder, Map Builder, and EAM
• Create maps and guidelines for healthcare EDI transactions such as 837, 834, 835, and 820
• Design, develop, and implement Edifecs solutions
• Address technical and business challenges related to EDI product upgrades
• Configure XEngine configuration files for trading-partner-specific validation
• Monitor and troubleshoot transmissions in Edifecs Transaction Manager
• Configure severity files for custom error validation
• Coordinate with application teams and support the QA team
• Serve as an expert technical and industry resource to management, clients, and development staff
• Consult on internal and industry IT technical and business-domain process capabilities
• Identify and recommend new IT opportunities and business operations related to application development
• Formulate and direct task identification, effort estimates, and work schedules for research, prototypes, and proof-of-concept activities
• Direct and participate in data management, application architecture, business architecture, and development tasks
• Guide staff on complex assignments and mentor them on new technologies
• Develop scalable, stable, and secure coding guidelines for software engineers
• Write quality code and assist with problem solving, root-cause analysis, troubleshooting, and coaching
• Write technical blogs and participate in the open-source community
• Apply Design Thinking techniques to application design
• Lead Agile software development efforts as a Technical Leader
• Coach engineers on TDD, ATDD, and pair programming
• Guide teams in establishing DevOps environments for applications
• Review application metrics and take action on code quality, business, and performance metrics
• Create load and performance testing strategies and perform advanced performance tuning
• Perform additional duties aligned with the role as assigned

Principal Software Engineer, EDI

Customer Support

• Support members and providers by facilitating care and service
• Assist Magellan members, providers, and clients regarding programs, policies, and procedures
• Handle incoming and outgoing calls related to healthcare benefits
• Administer intake documentation into appropriate systems
• Resolve callers' needs on the first call while meeting quality standards
• Research and communicate medical information about claims, eligibility, benefits, EAP services, claim status, and authorizations
• Identify and respond to crisis calls with appropriate resources
• Facilitate routine referrals and triage decisions not requiring clinical judgment
• Assemble and enter patient information into the appropriate delivery system
• Navigate Magellan systems and document customer comments and information
• Meet key performance indicators, service standards, and monthly call center metrics
• Support team members and participate in high-performance team activities
• Participate in training, self-development, career progression, and operational updates
• Identify operational problems or inefficiencies and support continuous improvement
• Lead or participate in activities improving Care Center performance, quality, and culture
• Read and retain information from multiple resources to address calls accurately

Customer Experience Associate

• Collaborate with internal business leaders to capture requirements, provide market analysis, develop negotiation strategies and manage the subcontracting process
• Communicate with internal stakeholders and negotiate directly with partners, subcontractors and consultants
• Build relationships with internal business owners to understand product and service requirements and execute subcontracts
• Prepare vendor agreements and related documents, review Prime contract terms and conditions, and ensure proper flowdown
• Facilitate and support negotiations and execution of contract documents
• Use a risk-based approach to develop negotiation strategies and subcontract language
• Support vendor due diligence and evaluation
• Obtain approvals from Legal, Compliance, IT, Security, requesting business areas and other stakeholders
• Liaise between Legal, internal business units and vendor representatives
• Provide expert consultation on subcontract language, contracting policies and procedures, contract issues and document administration
• Assist with new vendor implementations and transitions
• Monitor and manage expiring subcontracts for renewal or termination
• Build and maintain external subcontractor relationships for key vendors
• Develop and maintain vendor-related materials
• Identify process improvement and cost savings or avoidance opportunities
• Coordinate with Program Management on payment milestones, invoicing status, performance issues and funding limitations
• Maintain contractual documentation and file setup information, including agreements, modifications, task/delivery orders, funding and invoicing status, representations/certifications, supplier qualifications and correspondence
• Process and set up subcontracts and modifications through company purchasing policies and procedures
• Perform additional duties aligned with the intent of the role as assigned

Subcontracts Manager

• Support members and providers by facilitating care and service
• Assist members, providers, and clients with programs, policies, and procedures
• Handle incoming and outgoing calls related to healthcare benefits
• Administer intake documentation in appropriate systems
• Resolve callers’ needs on the first call while meeting quality standards
• Research and communicate medical information about services, claims, eligibility, benefits, EAP services, claim status, and authorizations
• Identify and respond to crisis calls with appropriate resources
• Facilitate routine referrals and triage decisions not requiring clinical judgment
• Assemble and enter patient information into appropriate delivery systems
• Navigate systems and document and forward customer information
• Meet service standards and monthly call center metrics
• Support team members and participate in high-performance team activities
• Participate in ongoing training and stay current on operational changes
• Identify and report operational problems and inefficiencies
• Lead or participate in activities improving Care Center performance, quality, and culture
• Read and retain information from multiple resources to address calls accurately