8/6/2018
Magellan Health
Ex. F 004
M H
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Care Manager - BH Brooklyn NY 11201
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Posted 30+ Days Ago
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Full time R00000019419
Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and sub‐ stance abuse services provided 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 sub‐ stance abuse issues, and participates in special quality improvement projects. ESSENTIAL FUNCTIONS: - Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effec‐ tiveness. - 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. In conjunction with providers and facilities, may develop discharge plans and oversee their implementation. May also perform 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 ques‐ tions and concerns regarding specific cases. - Participates in quality improvement activities, including data collection, track‐ ing, and analysis. - Maintains an active work load in accordance with National Care Manager performance standards. Works with community agencies as appropriate. Pro‐ poses 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.
About Us
Magellan is the employer of choice for hard working people interested in mak‐ ing a difference in the health care indus‐ try and in the communities where we work and live. Our strong culture of car‐ ing is the common thread in both our business strategy and our work environ‐ ment. We value professional growth and development, total health and wellness, rewards and recognition as well as em‐ ployee unity. Magellan is a place where you can thrive. Click here to search our openings. Magellan is committed to providing equal employment opportunities to em‐ ployees and applicants for employment without regard to race, color, creed, reli‐ gion, sex, gender identity and expression, sexual orientation, marital status, age,
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