Assists in processing difficult behavioral case management utilization requests in a timely manner according to company guidelines using current knowledge of the mental health system. Collects information about available services for specific communities. Serves as a resource to local agencies for current behavioral health care management systems.

• Attends meetings related to specific patient health care needs to assist in all stages of planning.

• Communicates service information to ensure the appropriate types of services are authorized.

• Solicits feedback regarding accuracy and completeness of provider requests.

• Uses feedback to prepare training sessions for providers to improve quality of submissions.

• Conducts on-site training for providers, stakeholders, placing agents and other human services agents to foster improved health care services and more cooperative relationships.

• Maintains open lines of communication to gain thorough understanding of provider operations.

• Networks with the department staff to document information on other regional areas in order to organize and expand service options.

• Provides accurate information to the client on provider activities to eliminate service gaps and to identify other potential issues.

• Types information into web-based system in an acceptable format to ensure accurate documentation and reporting.

• May process utilization review requests received by phone, fax or mail within established deadlines to determine medical necessity.

  Other Job Requirements

Responsibilities

Associate's or Bachelor's Degree in Nursing required with an LPN or RN license OR Bachelor's in Behavioral Health with LPC or LSW license.

Ability to use standard corporate software packages and corporate applications.

5+ years' experience in applicable field (e.g., psychiatric field).

General Job Information

Title

Clinical Reviewer, RN, LCPC, LCSW, LAC

Grade

24

Work Experience - Required

Clinical

Work Experience - Preferred

Education - Required

Associate - Nursing, Bachelor's - Behavioral Health

Education - Preferred

License and Certifications - Required

LPC - Licensed Professional Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Salary Range

Salary Minimum:

$58,440

Salary Maximum:

$93,500

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.

Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.

Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.

Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here (https://www.magellanhealth.com/media/760295/mg-federal-contractors-applicant-english.pdf) .

Warning: Employment Scam

It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. “Interviews” are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office.

Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.

If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911