Welcome to NASW Joblink - The Social Work Career Center
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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 and intermediate care settings. Collects and analyzes utilization data. Assists with discharge planning and ambulatory follow up activity. Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects.
Monitors inpatient and intermediate 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 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.
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.
Licensure is required for this position, specifically current license as a Registered Nurse (RN) or Masters or Doctoral-level behavioral health practitioner that meets State, Commonwealth or customer-specific requirements. Licensure may also include one or more of the following: CEAP, LMSW, LCSW or LPN. CEAP certification as required by management. Ability to meet Magellan credentialing requirements for independent professional practice IF performing TRF reviews (Masters level licensed behavioral health professional). 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 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., Minimum 2 years experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care setting.
We focus on the health and well-being of every individual that we serve. We connect behavioral, physical, pharmacy and social needs into a complete picture of care that’s personalized, coordinated and cost-effective. By turning fragmented care into focused care, we empower 1 in 10 Americans to lead healthier, more vibrant lives every day.We manage the fastest growing, most complex areas of health,... including special populations, complete pharmacy benefits and other specialty areas of healthcare. Magellan’s customers include health plans and other managed care organizations, employers, labor unions, various military and governmental agencies and third-party administrators.