Liable for the supervision and coordination of care management employees, together with intensive care management employees, offering experience in designated packages.ESSENTIAL FUNCTIONSAssists medical management within the improvement and on-going management of a delegated staff of clinicians. Performs care management assessment actions in keeping with Magellan insurance policies, procedures, and requirements. Conducts recruitment, interviewing, and choice of correctly certified medical employees members and ensures applicable orientation is offered. Often screens the efficiency of care management employees. Supervises care management employees together with performing annual evaluations and supplies counseling and disciplinary motion as needed. Coordinates high quality enchancment actions beneath the course of medical management. Assists medical management within the improvement of strategic and operational objectives and plans. Assists medical management within the identification and coordination of the required medical and shopper service coaching wants. Beneath the steerage of medical management, capable of assessment and monitor care managers efficiency; present suggestions and counseling; and take part within the hiring of medical employees. Potential to research particular utilization issues, plan and implement options that instantly affect high quality of care and price effectivity. Supervise the gathering of pertinent medical info whereas sustaining a great rapport and relationship with psychological well being and substance abuse suppliers.QUALIFICATIONSEducation: Nursing-BSN required; Social Work-MSW required.Expertise: 5 years submit diploma expertise in a direct care medical setting; managed care expertise most popular. 1 yr direct supervisory expertise required.Information, Expertise, Talents: Thorough information of bodily, medical specialty and/or psychological well being group assets and suppliers. Thorough information of healthcare providers in bodily well being, behavioral well being or different medical specialty space based mostly on pod management. Appreciable talent in deciphering medical remedy info and making applicable referral and triage selections. Should meet Magellan’s credentialing standards for RN, Masters or Doctoral degree supplier.Basic Job Info TitleUtilization Management Manager – Miami, FLJob FamilyCare ManagementCountryUnited States of AmericaFLSA StatusUnited States of America (Exempt)Recruiting Begin Date2/19/2016Date Requisition Created2/19/2016Minimal QualificationsEducationBachelorsBachelors: Nursing (Required)License and CertificationsLCSW – Licensed Medical Social Employee – Care Mgmt, LMSW – Licensed Grasp Social Employee – Care Mgmt, RN – Registered Nurse, State and/or Compact State Licensure – Care MgmtOther Job RequirementsResponsibilities5 years submit diploma expertise in a direct care medical setting; managed care expertise most popular. 1 yr direct supervisory expertise required., – Thorough information of bodily, medical specialty and/or psychological well being group assets and suppliers.- Thorough information of healthcare providers in bodily well being, behavioral well being or different medical specialty space based mostly on pod management.- Appreciable talent in deciphering medical remedy info and making applicable referral and triage selections.
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Magellan Health Providers, Inc. (Magellan) is engaged within the specialty managed healthcare enterprise. Magellan supplies providers to well being…
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