Care Manager, BH - Remote PA

Care Manager, BH – Remote PA

This is a remote position and candidates need to be licensed in PA.

• Authorizes and reviews utilization of mental health and substance abuse services in inpatient and/or 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 and/or 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 and/or outpatient care and other levels of care as allowed by scope of practice and experience.
• Develops discharge plans in conjunction with providers and facilities and oversees 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, company policies, 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 workload in accordance with National Care Manager performance standards.
• Works with community agencies as appropriate and 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 and interacts with providers in a professional, respectful manner that facilitates the treatment process.

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Licensure – One or more of the following licenses is required: CEAP, LMSW, LCSW, LSW, LPC, or RN. License must be current and meet State or customer‑specific requirements.

Experience – Minimum 2 years of post‑degree experience in a healthcare, behavioral health, psychiatric, and/or substance abuse health care setting.

Skills & Knowledge – Strong organization, time management and communication skills; knowledge of utilization management procedures, mental health and substance abuse community resources and providers; knowledge of inpatient and/or outpatient settings; DSM‑V or most current diagnostic edition; ability to analyze utilization problems and implement solutions that directly influence quality of care.

Title
:
Care Manager, BH – Remote PA

Grade
: 25

Work Experience - Required
:
Clinical

Work Experience - Preferred
:
None listed

Education - Required
:
Associate in Nursing, Bachelor's in Social Work, Master's in Social Work

Education - Preferred
:
None listed

License and Certifications - Required – CEAP, LCSW, LMSW, LPC, LSW, RN (State and/or Compact State Licensure)

License and Certifications - Preferred
:
None listed

Salary Minimum
: $64,285

Salary Maximum
: $102,855

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 individual's skills, experience, education, and other job‑related factors permitted by law.

This position may be eligible for short‑term 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 Tobacco‑free workplace. EOE/M/F/Vet/Disabled.

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.