Care Manager, Health Plan – Licensed/Remote in CA
Opportunité de Carrière : Care Manager chez Magellan Health
Sous-titre : Un poste clé dans la gestion des soins à distance en Californie
Magellan Health, un acteur majeur dans le secteur de la santé, recherche un *Care Manager* qualifié pour un poste flexible à distance, spécifiquement pour les candidats résidant en Californie et titulaires d’un permis d’exercice. Ce rôle s’inscrit dans une dynamique pluridisciplinaire, visant à offrir des services de santé de qualité centrés sur le patient.
Responsabilités Principales
Le Care Manager joue un rôle crucial dans la conception et la mise en œuvre de **plans de soins individualisés** pour les membres, notamment ceux bénéficiant de Medicaid, Medicare, et Whole Health. Ses principales responsabilités incluent :
- *Évaluation et planification des soins :* Réaliser des évaluations initiales et continues pour la priorisation des soins, en garantissant la conformité avec les critères médicaux.
- *Gestion des équipes de soutien :* Superviser le personnel de soutien non licencié pour atteindre les niveaux de performance établis par les dirigeants de marché.
- *Intervention en situation de crise :* Fournir un soutien téléphonique et des interventions adaptées pour les membres identifiés comme à besoins élevés.
- *Éducation et sensibilisation :* Former les prestataires et les familles aux stratégies de gestion des soins, promouvant ainsi une approche centrée sur le membre.
Exigences du Poste
Les candidats doivent répondre à un certain nombre de critères pour être considérés pour ce poste :
- **Licences et Certification :** Un permis valide est requis, tel que LCSW, LMSW, LPC, ou RN, en plus d’une expérience minimum de 5 ans dans des environnements de soins de santé ou de santé comportementale.
- **Compétences en Gestion :** Capacité à organiser, à gérer le temps et à communiquer efficacement, tout en supervisant les activités des équipes de soutien assignées.
- **Connaissances Professionnelles :** Compréhension des procédures de gestion des soins, ainsi que des ressources communautaires relatives à la santé mentale.
Conditions de Travail et Rémunération
Le poste est éligible à un éventail d’avantages sociaux afin d’améliorer le bien-être physique, mental et émotionnel des employés. La fourchette salariale pour ce rôle s’étend de **64 285 $ à 102 855 $** par an, ajustée en fonction de l’expérience et des qualifications des candidats.
Une Égalité des Chances Promue
Magellan Health se distingue par son engagement à offrir des chances égales à tous les candidats et à maintenir un environnement de travail exempt de tabac. L’entreprise soutient activement la diversité et lutte contre toute forme de discrimination.
Postulez Maintenant
Cette opportunité de poste représente un engagement significatif envers l’amélioration de la santé communautaire par le biais d’une gestion des soins attentive. Postulez dès maintenant !
📅 Date de publication de l’offre : Wed, 04 Jun 2025 07:32:43 GMT
🏢 Entreprise : Magellan Health
📍 Lieu : San Diego, CA
💼 Intitulé du poste : Care Manager, Health Plan – Licensed/Remote in CA
💶 Rémunération proposée : $64285 per year
📝 Description du poste : This is a remote position in California, candidates must be licensed and reside in CA.This position is responsible for the assessment, reassessment, care planning and coordination of care and services including ongoing monitoring of an appropriate and effective person-centered care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity criteria. Responsible for the development of individualized care plans for high and moderate stratified members in the Medicaid, Medicare, and Whole Health markets. Possesses clinical knowledge, understands best practices and continuous learning skills, reviews member records, and works in conjunction with primary care, community benefits, and other support opportunities to develop a long term care plan to guide the member through their mental health care. Oversees the work of its assigned care support team and work with non-licensed support staff to meet standards of care and performance set by Member Market Leads and the Care Management Center of Operational Excellence (CoOE) Lead.
- Accountable for all Care Management activities for assigned high and moderate members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple clinical, social, and community resources.
- Provides telephone triage, crisis intervention and prior authorizations as assigned for select members stratified as high and moderate member need.
- Conducts in depth health risk assessment and/or comprehensive needs assessment including, but not limited to, psycho-social, physical, medical, behavioral, environmental, and financial parameters.
- Develops, documents, implements, and communicates the patient-centered care plan, which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
- Educates providers, supporting staff, members and families regarding care management role and health strategies with a focus on member-focused approach to care.
- Serves as an accountable member of the care team to oversee appropriate rendering of services (e.g., during transitions in care or transition to home care, back up plans, community-based services).
- Oversees and effectively manages work assigned and conducted by assigned care support team
- Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.
- Acts as an advocate for members’ care needs by identifying and addressing gaps in care.
- Performs ongoing monitoring of members’ care plan and measures the effectiveness of interventions as identified; develops plans that strive to meet Magellan developed KPIs in accordance with the CM CoOE Lead and Member Market Leads.
- Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes.
- Works with members and the interdisciplinary care plan team to adjust plan of care as necessary.
- Facilitates a team approach, including all participants of the Interdisciplinary Care Plan team, Health Plan Medical Care Management where appropriate, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.
Other Job RequirementsResponsibilities Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements.
One or more of the following licensure is required for this role with necessary degrees, LMSW, LCSW, LPC, or RN.
Minimum 5 years experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care setting.
Strong organization, time management and communication skills.
Ability to manage and oversee activities of assigned care support teams.
Experience with Care Management flows.
Knowledge of utilization management procedures, mental health and substance abuse community resources and providers.
Knowledge and experience in inpatient and/or outpatient 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.
Understanding of plan benefit structures, psychiatric/medical terminology, call center terminology and operations.
Strong written and verbal communication skills.General Job InformationTitle Care Manager, Health Plan – Licensed/Remote in CAGrade 25Work Experience – Required Behavioral Health, HealthcareWork Experience – PreferredEducation – Required Bachelor’s – Nursing, Master’s – Counseling, Master’s – Social WorkEducation – PreferredLicense and Certifications – Required LCSW – Licensed Clinical Social Worker – Care Mgmt, LMFT – Licensed Marital and Family Therapist – Care Mgmt, LMSW – Licensed Master Social Worker – Care Mgmt, LPC – Licensed Professional Counselor – Care Mgmt, RN – Registered Nurse, State and/or Compact State Licensure – Care MgmtLicense and Certifications – PreferredSalary RangeSalary Minimum: $64,285Salary Maximum: $102,855This 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.
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