Care Manager, BH - Remote (Louisiana license required)

📋 Description

• • Serve as the clinical quarterback for Louisiana members facing mental-health and substance-use challenges, working 100 % remotely while ensuring every authorization, review, and discharge plan meets the highest standards of medical necessity and member advocacy.
• • Own the full continuum of utilization management: authorize inpatient and outpatient behavioral-health services, perform concurrent reviews, and intervene in real time when care veers off course—always guided by DSM-5 criteria, Magellan guidelines, and Louisiana regulations.
• • Collect, analyze, and translate utilization data into actionable insights that improve quality, reduce readmissions, and lower costs—then present findings to internal stakeholders and community partners to drive system-wide change.
• • Provide 24/7 telephone triage, crisis intervention, and emergency authorizations, de-escalating high-risk situations and connecting members to the right level of care within minutes, not hours.
• • Partner with psychiatrists, therapists, hospitals, and community agencies to craft and oversee discharge plans that bridge gaps between levels of care, ensuring continuity and preventing relapse.
• • Educate members and providers on benefits, covered services, network resources, and evidence-based treatment options—translating complex insurance language into clear, compassionate guidance.
• • Collaborate with Physician Advisors on complex cases, presenting concise clinical summaries and alternative treatment options when services do not meet medical-necessity criteria.
• • Lead or contribute to targeted quality-improvement projects—design data-collection tools, track outcome metrics, and implement evidence-based interventions that elevate the standard of behavioral-health care across Louisiana.
• • Proactively identify gaps in the provider network, recruit high-quality clinicians, and maintain an active caseload that meets or exceeds National Care Manager performance benchmarks.
• • Champion a culture of respect and professionalism in every provider interaction, modeling trauma-informed communication and fostering collaborative relationships that accelerate recovery.
• • Maintain impeccable documentation in Magellan’s electronic systems, ensuring every authorization, denial, and appeal is defensible, audit-ready, and aligned with regulatory requirements.
• • Stay current on evolving state and federal regulations, payer policies, and best-practice literature, translating new knowledge into improved workflows and member outcomes.
• • Serve as a visible ambassador for Magellan’s mission of “making a difference,” participating in community coalitions, workforce development initiatives, and educational webinars that expand access to care.
• • Embrace additional duties as assigned—whether piloting a new telehealth program, mentoring junior care managers, or supporting disaster-response efforts—knowing that flexibility fuels innovation.