Utilization Review Nurse Salary in Albuquerque, NM

Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties are typically performed during face-to-face home visits. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate.Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services).Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.Acts as an advocate for member`s care needs by identifying and addressing gaps in care.Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan.Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.Facilitates a team approach to the coordination and cost effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases.Provides assistance to members with questions and concerns regarding care, providers or delivery system.Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.Generates reports in accordance with care coordination goal.Other Job RequirementsResponsibilities3-5 years experience in Social Work, Nursing, or Healthcare-related field, or relevant experience in lieu of degree., Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required.Experience in analyzing trends based on decision support systems.Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.Knowledge of referral coordination to community and private/public resources.Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data.Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking.Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols.Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures.Ability to maintain complete and accurate enrollee records.Effective verbal and written communication skills. Ability to work well with clinicians, hospital officials and service agency contacts.General Job InformationTitleCare CoordinatorGrade22Work Experience - RequiredClinical, QualityWork Experience - PreferredEducation - RequiredGED, High SchoolEducation - PreferredAssociate, Bachelor'sLicense and Certifications - RequiredDL - Driver License, Valid In State - OtherLicense and Certifications - PreferredCCM - Certified Case Manager - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtSalary RangeSalary Minimum:$50,225Salary Maximum:$75,335This 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.

Independently coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties performed are either during face-to-face home visits or facility based depending on the assignment. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate. May act as a team lead for non-licensed care coordinators.Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately (e.g., during transition to home care, back up plans, community based services).Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.Acts as an advocate for members' care needs by identifying and addressing gaps in care.Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan.Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.Facilitates a team approach to the coordination and cost effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases.Provides assistance to members with questions and concerns regarding care, providers or delivery system.Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.Generates reports in accordance with care coordination goals.Other Job RequirementsResponsibilitiesAssociate's Degree in Nursing required for RNs, or Master's Degree in Social Work or Healthcare-related field, with an independent license, for Social Workers.Licensed in State that Services are performed and meets Magellan Credentialing criteria.2+ years' post-licensure clinical experience.Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required.Experience in analyzing trends based on decision support systems.Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.Knowledge of referral coordination to community and private/public resources.Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data.Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking.Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols.Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures.Ability toestablish strong working relationshipswith clinicians, hospital officials and service agency contacts. Computer literacy desired.Ability to maintain complete and accurate enrollee records. Effective verbal and written communication skills.General Job InformationTitleCare Coordinator, LicensedGrade24Work Experience - RequiredClinicalWork Experience - PreferredEducation - RequiredAssociate - Nursing, Master's - Social WorkEducation - PreferredLicense and Certifications - RequiredDL - Driver License, Valid In State - Other, LISW - Licensed Independent Social Worker - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtLicense and Certifications - PreferredSalary RangeSalary Minimum:$58,440Salary Maximum:$93,500This 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.

Executes the learning and development priorities for the company's training needs. Responsible for developing, scheduling and conducting group and/or one-on-one training, for both virtual and classroom settings. At times it is necessary to conduct classes with virtual participants both face-to-face and virtually; virtual facilitation and technical skills are required for this reason. Training will be developed and delivered for both newly hired and existing staff on policies, standards, computer systems, service delivery expectations, quality monitoring and regulation and accreditation specifics. Collaborates with COE leaders and workgroup project managers to identify, prioritize and respond to training needs of staff. Although primarily supports COE training, may be expected to lead and/or support other initiatives and programs (i.e. Leadership Programs, competency development, and new business implementations). Includes additional departmental responsibilities and tasks such as learning management system administrator, training material development and maintenance, audit and completion reports and special projects.Maintains subject matter expertise with company policies, COE and site procedures and systems, and clinical care management processes.Provides classroom and/or one-on-one instruction for new employees on company policies, COE and site procedures and systems, and clinical care management processes.Provides instruction for both newly hired clinical staff, staff being cross-trained on other accounts, and sustainment training for existing staff. Utilizes a variety of learning interventions in response to individual learning styles.Collaborates with Corporate Clinical Operations, IT Project Management, Talent Development and other stakeholders to work on projects, influence change management, drive training strategy and coordinate project rollouts. Serves as an advocate for learning and change management in project planning meetings and effectively communicate project plans, milestones and training strategy on an ongoing basis.Leads and/or co-leads the overall design, development and delivery of Clinical and other learning products/services/interventions, including specific needs analysis, learning outcomes definition, structure and design of learning product, implementation plan, communication with relevant stakeholders and follow up evaluations to demonstrate learning transfer.Leads and/or supports business/systems migrations and new office openings by developing training plan, agendas/schedules, developing/customizing content, delivering training and mentoring staff, including COE and special projects.Participates in clinical management team to develop and implement clinical services and training strategies that address performance gaps. Analyzes performance and develop, in consultation with clinical and quality management, improvements in clinical processes. Works with quality management in preparing materials for customer audits and accreditation visits to appropriately reflect adherence to policies and procedures and improvements in work processes.Assures site is in compliance with training standards as required by state and national regulations, and develops new training as these regulations are updated.Researches, develops and maintains manuals and documentation of procedures, training program and support materials, and training/job aids for customer accounts and prepares materials as necessary for customer review and audit. Designs and develops appropriate and effective instructional materials and content in collaboration with other learning partners in the department Conducts developmental and refresher training for existing clinical staff to implement process changes, correct deficiencies and improve individual performance.Utilizes enterprise Learning Management System to share training resources and information, training materials, track training activity, report on progress, and support enterprise learning strategy.Other Job RequirementsResponsibilities3+ years ofexperiencein managed clinical care, formal training design and/or facilitation and coaching experience.3+ years of experience post degree in psychiatric and/or substance abuse health care setting, including utilization review.Licensure is required for this position, specifically a current license that meets State, Commonwealth or customer-specific requirements. Ability to effectively prioritize and manage competing priorities; good time management skills.Demonstrated understanding of training concepts and principles of adult learning.Demonstrated ability to convert abstract ideas into concrete solutions, and ability to communicate technical information to non-technical customers. Comfortable working in a fast-paced environment. Strong facilitation and classroom management skills. Strong verbal and written communication skills; ability to provide topic clarity to all levels.Good interpersonal skills; ability to function independently and as a team member. Understanding of managed care/healthcare operations. Skilled in use of MS Word (creating tables, managing formatting, saving versions), Excel, PowerPoint (creating presentations, using animation), Outlook.Excellent training documentation skills, including manuals, job aids and facilitator/learner materials.General Job InformationTitleClinical TrainerGrade24Work Experience - RequiredClinical, TrainingWork Experience - PreferredEducation - RequiredAssociate - Nursing, Master's - Psychology, Master's - Social WorkEducation - PreferredLicense and Certifications - RequiredLCSW - 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, PsyD - Doctorate of Psychology - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtLicense and Certifications - PreferredSalary RangeSalary Minimum:$58,440Salary Maximum:$93,500This 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.

Receive 17% weekday nights, 26% weekend nights, or 15% weekend day shift differentials!Department: Nursing Services Administratio - SRMCFTE: 0.60Part TimeShift: NightsPosition Summary:Responsible for the overall operations, and implementation and evaluation of activities for inpatient and emergency care at SRMC. Devotes a majority of work time to supervisory duties and regularly directs the work of two or more other employees. Role accountabilities will ensure the delivery of optimal and safe patient care which includes fiscal management, standards compliance, clinical practice, staff development, oversight and active participation in clinical practice, and performance improvement activities that evaluate program effectiveness. Role includes frequent new and varied work situations. The role involves a high degree of complexity. Role operates independently with minimal supervision. Role works to determine own practices and procedures and also contribute to the development of new concepts. Ensure adherence to Hospitals and departmental policies and procedures. Patient care may include Neonate, Adolescent, Adult, and Geriatric age groups.Detailed responsibilities:* PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols* PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes* PATIENT SAFETY 3 - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk* PATIENT SAFETY 4 - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner* PATIENT SAFETY 5 - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right"* COORDINATION - Collaborate with Admitting Office, physicians, and patient care areas when needed as consultant to facilitate appropriate patient placement based on admitting service, diagnosis, acuity, census, and staffing considerations* DECISION MAKING - Participate in key decision making regarding overall planning, work redesign, and staff development associated with implementing changes in patient care delivery* MISCELLANEOUS - Perform miscellaneous job-related duties as assigned* UTILIZATION - Facilitate between hospital/system administration, departments, and medical staff ensuring cost-effective utilization of products, services, processes and resources* COMPLIANCE - Ensure compliance with all regulatory agencies, governing health care delivery and the rules of accrediting bodies by continually monitoring Hospital operations and programs and physical properties; initiate changes as required* EVALUATION - Administers or makes recommendations regarding performance evaluations, promotions, administration of personnel policies with staff, hiring or discipline* POLICIES AND PROCEDURES - Maintain established departmental policies and procedures, objectives, and quality assurance programs* PROFESSIONAL DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops* GUIDELINES AND STANDARDS - Organize and direct clinical practice in collaboration with the program medical director through development, implementation and maintenance of practice guidelines/standards* QUALITY - Actively participate in nursing strategic initiatives such as quality improvement and monitoring, regulatory compliance, recruitment and retention of staff and patient and employee satisfaction* LIAISON - Act as a resource & liaison among the hospital, department, health system entities, other institutions and agencies* TRANSFERS - Participate and authorize transfers to and from other facilities with appropriate physicians, and reviewing all paperwork prior to ensure EMTLA guidelines are met* REPORTING - Reports any incidents, and convey staff concerns and identified problems to Administration* PATIENT CARE - Assign duties in accordance in conjunction with the unit director or designee with the plan of care, patient needs, and within the scope of staff qualifications and licensure/certification/registry, being able to reallocate staff via floating, implementing census management as necessary to balance patient care needs with decisions that reflect concern for the quality of care and cost effective use of resources* SUPERVISION - Supervise and direct staff providing patient care; accountable for care provided to patients on assigned shifts. Round on all departments on responsible shifts, meeting with Charge Nurse to evaluate unit needs* PATIENT CARE - Assist with or institute emergency measures for sudden, adverse developments in patients as Lead Rapid Response nurse; respond to all Code Blue events and initiate ACLS protocols as necessary* LIAISON - Act as liaison as necessary between physicians, staff, patients, families, and other departments to promote and facilitate communication, problem solving, decision-making, crisis intervention, resource utilization, and conflict management* PATIENT SAFETY - Report potential and actual patient safety, concerns, medical errors and or near misses in a timely manner thru the chain of command and document within the PSN system* PATIENT CARE - Establish a compassionate environment by providing emotional psychological and spiritual support to patient, friends and familiesQualificationsEducation:Essential:* Program GraduateNonessential:* Bachelor's DegreeEducation specialization:Essential:* Nationally Accredited Nursing GraduateNonessential:* BSN or MSNExperience:Essential:4 years directly related experienceNonessential:Credentials:Essential:* Basic Arrhythmia Cert w/in 1 year* PALS w/in 6 months of position* RN in NM or as allowed by reciprocal agreement by NM* CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days* Advanced Cardiac Life Support Certification w/in 6 months* Trauma Nursing Core Course (TNCC) w/in 6 months of hireNonessential:* Instructor in BLS, ACLS, PALS and/or TNCC* National CertificationPhysical Conditions:Medium Work: Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work.Working conditions:Essential:* Med Haz: Dirt, dust, fumes, odors, bad weather, noiseDepartment: Registered Nurse

Receive 17% weekday nights, 26% weekend nights, or 15% weekend day shift differentials!Department: Nursing Services Administratio - SRMCFTE: 0.05Casual Pool (as needed)Shift: DaysPosition Summary:Responsible for the overall operations, and implementation and evaluation of activities for inpatient and emergency care at SRMC. Devotes a majority of work time to supervisory duties and regularly directs the work of two or more other employees. Role accountabilities will ensure the delivery of optimal and safe patient care which includes fiscal management, standards compliance, clinical practice, staff development, oversight and active participation in clinical practice, and performance improvement activities that evaluate program effectiveness. Role includes frequent new and varied work situations. The role involves a high degree of complexity. Role operates independently with minimal supervision. Role works to determine own practices and procedures and also contribute to the development of new concepts. Ensure adherence to Hospitals and departmental policies and procedures. Patient care may include Neonate, Adolescent, Adult, and Geriatric age groups.Detailed responsibilities:* PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols* PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes* PATIENT SAFETY 3 - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk* PATIENT SAFETY 4 - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner* PATIENT SAFETY 5 - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right"* COORDINATION - Collaborate with Admitting Office, physicians, and patient care areas when needed as consultant to facilitate appropriate patient placement based on admitting service, diagnosis, acuity, census, and staffing considerations* DECISION MAKING - Participate in key decision making regarding overall planning, work redesign, and staff development associated with implementing changes in patient care delivery* MISCELLANEOUS - Perform miscellaneous job-related duties as assigned* UTILIZATION - Facilitate between hospital/system administration, departments, and medical staff ensuring cost-effective utilization of products, services, processes and resources* COMPLIANCE - Ensure compliance with all regulatory agencies, governing health care delivery and the rules of accrediting bodies by continually monitoring Hospital operations and programs and physical properties; initiate changes as required* EVALUATION - Administers or makes recommendations regarding performance evaluations, promotions, administration of personnel policies with staff, hiring or discipline* POLICIES AND PROCEDURES - Maintain established departmental policies and procedures, objectives, and quality assurance programs* PROFESSIONAL DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops* GUIDELINES AND STANDARDS - Organize and direct clinical practice in collaboration with the program medical director through development, implementation and maintenance of practice guidelines/standards* QUALITY - Actively participate in nursing strategic initiatives such as quality improvement and monitoring, regulatory compliance, recruitment and retention of staff and patient and employee satisfaction* LIAISON - Act as a resource & liaison among the hospital, department, health system entities, other institutions and agencies* TRANSFERS - Participate and authorize transfers to and from other facilities with appropriate physicians, and reviewing all paperwork prior to ensure EMTLA guidelines are met* REPORTING - Reports any incidents, and convey staff concerns and identified problems to Administration* PATIENT CARE - Assign duties in accordance in conjunction with the unit director or designee with the plan of care, patient needs, and within the scope of staff qualifications and licensure/certification/registry, being able to reallocate staff via floating, implementing census management as necessary to balance patient care needs with decisions that reflect concern for the quality of care and cost effective use of resources* SUPERVISION - Supervise and direct staff providing patient care; accountable for care provided to patients on assigned shifts. Round on all departments on responsible shifts, meeting with Charge Nurse to evaluate unit needs* PATIENT CARE - Assist with or institute emergency measures for sudden, adverse developments in patients as Lead Rapid Response nurse; respond to all Code Blue events and initiate ACLS protocols as necessary* LIAISON - Act as liaison as necessary between physicians, staff, patients, families, and other departments to promote and facilitate communication, problem solving, decision-making, crisis intervention, resource utilization, and conflict management* PATIENT SAFETY - Report potential and actual patient safety, concerns, medical errors and or near misses in a timely manner thru the chain of command and document within the PSN system* PATIENT CARE - Establish a compassionate environment by providing emotional psychological and spiritual support to patient, friends and familiesQualificationsEducation:Essential:* Program GraduateNonessential:* Bachelor's DegreeEducation specialization:Essential:* Nationally Accredited Nursing GraduateNonessential:* BSN or MSNExperience:Essential:4 years directly related experienceNonessential:Credentials:Essential:* Basic Arrhythmia Cert w/in 1 year* PALS w/in 6 months of position* RN in NM or as allowed by reciprocal agreement by NM* CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days* Advanced Cardiac Life Support Certification w/in 6 months* Trauma Nursing Core Course (TNCC) w/in 6 months of hireNonessential:* Instructor in BLS, ACLS, PALS and/or TNCC* National CertificationPhysical Conditions:Medium Work: Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work.Working conditions:Essential:* Med Haz: Dirt, dust, fumes, odors, bad weather, noiseDepartment: Registered Nurse

Supporting Care Coordinators with triaging transitions from higher to lower levels of care for in-state and out of state discharge planning using individual planning process. Works closely with CFYD permanency placement coordinators to establish appropriate transitions as recommended by the treatment team.Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties are typically performed during face-to-face home visits. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate.Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services).Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.Acts as an advocate for member`s care needs by identifying and addressing gaps in care.Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan.Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.Facilitates a team approach to the coordination and cost effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases.Provides assistance to members with questions and concerns regarding care, providers or delivery system.Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.Generates reports in accordance with care coordination goal.Other Job RequirementsResponsibilities3-5 years experience in Social Work, Nursing, or Healthcare-related field, or relevant experience in lieu of degree., Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required.Experience in analyzing trends based on decision support systems.Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.Knowledge of referral coordination to community and private/public resources.Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data.Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking.Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols.Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures.Ability to maintain complete and accurate enrollee records.Effective verbal and written communication skills. Ability to work well with clinicians, hospital officials and service agency contacts.General Job InformationTitleCISC Transition of Care CoordinatorGrade22Work Experience - RequiredClinical, QualityWork Experience - PreferredEducation - RequiredGED, High SchoolEducation - PreferredAssociate, Bachelor'sLicense and Certifications - RequiredDL - Driver License, Valid In State - OtherLicense and Certifications - PreferredCCM - Certified Case Manager - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtSalary RangeSalary Minimum:$50,225Salary Maximum:$75,335This 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.

Responsible for the management, direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care management staff, providing expertise in designated programs.Assists clinical management in the development and on-going management of designated staff.Performs care management review activities consistent with Magellan policies, procedures, and standards.Conducts recruitment, interviewing, and selection of properly qualified staff members and ensures appropriate orientation is provided.Regularly monitors the performance of care management staff. Monitors adherence to the efficiency goals for all staff including case volume, case closure rates, average handle time and other metrics.Supervises care management staff through approved audit processes including performing annual reviews and provides counseling and disciplinary action as necessary.Coordinates quality improvement activities under the direction of clinical management.Assists management in the development of strategic and operational goals and plans.Assists management in the identification and coordination of the necessary clinical and client service training needs.Analyzes specific utilization problems, plans and implements solutions that directly influence quality of care and cost efficiency.Supervises the collection of pertinent clinical information while maintaining a good rapport and relationship with providers.Other Job RequirementsResponsibilities5 years post degree experience in a direct care clinical setting; managed care experience preferred.One or more of the following current, activelicenses are required: BCBA, LCSW, LMFT,LMSW, LPCC,LPC, PCor RN.If RN, BSN preferred but ASN considered with additional experience.Thorough knowledge of physical, medical specialty and/or mental health community resources and providers.Thorough knowledge of healthcare services in physical health, behavioral health or other medical specialty area based on pod management.Considerable skill in interpreting clinical treatment information and making appropriate referral and triage decisions.Must meet Magellan's credentialing criteria for RN, Masters or Doctoral level provider.General Job InformationTitleMgr, Clinical Care ServicesGrade27Work Experience - RequiredClinicalWork Experience - PreferredEducation - RequiredAssociate - Nursing, Master's - Behavioral HealthEducation - PreferredBachelor's - NursingLicense and Certifications - RequiredBCBA - Board Certified Behavior Analyst - Care Mgmt, Current licensure required for this position that meets State, Commonwealth or customer-specific requirements - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, PC - Professional Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtLicense and Certifications - PreferredSalary RangeSalary Minimum:$77,785Salary Maximum:$124,455This 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.