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Care Manager, BH
Magellan Health. Authorize and review utilization of mental health and substance abuse services in inpatient and/or outpatient care settings .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in utilization management and care coordination within mental health and substance abuse settings, with a strong focus on quality improvement and patient advocacy. Proficient in analyzing utilization data and implementing solutions to enhance the quality of care.
Highest-signal resume keywords
Utilization Management ProceduresMental Health And Substance Abuse KnowledgeCrisis InterventionQuality Improvement ProjectsLicensure In Social Work Or Nursing
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization Data AnalysisDischarge PlanningConcurrent ReviewsTelephone TriageEmergency AuthorizationsClinical ReviewsKnowledge Of DSM VCare CoordinationPatient AdvocacyImplementation Of Treatment Plans
Soft Skills
Strong Organization SkillsTime ManagementCommunication Skills
Certifications & Qualifications
CEAPLMSWLCSWLSWLPCRN
Industry Keywords
Behavioral HealthPsychiatric CareSubstance AbuseInpatient CareOutpatient CareManaged Care ProgramsCommunity ResourcesQuality StandardsHealthcare ComplianceNetwork Development
About the role
Key responsibilities & impact- 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
- Monitor levels of care to ensure medical necessity and effectiveness
- Provide telephone triage, crisis intervention, and emergency authorizations
- Perform concurrent reviews for inpatient, outpatient, and other applicable levels of care
- Develop discharge plans with providers and facilities and oversee implementation
- Perform quality clinical reviews, educate members and providers, and make interventions to advance care
- Provide information about benefits, community resources, managed care programs, policies, procedures, and criteria
- Interact with Physician Advisors regarding clinical and authorization questions
- Participate in data collection, tracking, and analysis for quality improvement
- Maintain an active 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
Requirements
What you’ll need- Current license meeting State, Commonwealth, or customer-specific requirements
- One or more of the following required licenses with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC, or RN
- Minimum 2 years of experience post degree in healthcare, behavioral health, psychiatric, and/or substance abuse healthcare 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 utilization problems and plan and implement solutions influencing quality of care
- Required education: Associate in Nursing, Bachelor's in Social Work, or Master's in Social Work
- Every employee must understand, comply with, and attest to security responsibilities and controls unique to the position, as well as applicable legal, regulatory, contractual, and internal policy requirements
Benefits
Comp & perks- Short-term incentives may be available
- Comprehensive benefits package
- Health benefits
- Life benefits
- Voluntary benefits
- Other benefits and perks supporting physical, mental, emotional, and financial wellbeing
- Tobacco-free workplace
- Equal opportunity employer