• Job Description

  Req#: R00000068225

  Responsible for promoting integrated health practices through assessment, care planning and coordination of care and services. Includes ongoing monitoring of an appropriate and effective person-centered care plan, member education on health-related social needs, and care management. Entails coordination with PA HealthChoices physical health managed care organizations, members and community providers.

  This is a remote position, however, candidates need to reside in the Yardley, PA area for travel to providers offices in the vicinity.

  Responsible for the assessment, reassessment, care planning and coordination of care and services. Includes ongoing monitoring of an appropriate and effective person centered care plan, member education and care management. Regularly communicates with the members' PCPs and other providers, and integrates the member, caregiver and other provider feedback into the assessment and planning.

  • Ensures continuity of care for newly enrolled members.
  • Identifies and prioritizes the members' needs and preferences.
  • Develops quantifiable goals and desired outcomes, and promotes the members' ability to self-manage to the greatest extent possible.
  • Develops, implements and monitors the Person Centered Service Plan, assisting members in obtaining reasonable accommodations when appropriate.
  • Manages case load, including risk stratification of members, monitoring reassessment needs and facilitating transitions of care settings.
  • Serves as the primary point of member contact.
  • Assesses member needs, manages care and services, and ensures effective communication among members, caregivers, providers and community supports.
  • As the lead of the interdisciplinary team, facilitates the activities and communication within an interdisciplinary team of providers, vendors, facilities, discharge planners, field nurses, social workers, care coordinators, and member/caregivers to effectively manage care plans and transitions of care settings.
  • Maintains timely, complete and accurate documentation using both hard copy and technology based solutions in compliance with regulatory policies and procedures.
  • Gathers and summarizes data for reports.
  • Supports initiatives of the Quality Assessment and Performance Improvement Committee.

  The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

  Other Job Requirements

  Responsibilities

  Understands and is able to apply principles of Care Management and Person Centered Service Planning.
  Ability to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines.
  Ability to understand and apply coverage guidelines and benefit limitations.
  Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses (depression, challenging behaviors, Alzheimer's disease and other disease-related dementias).
  Understands and adapts appropriately to issues related to communication, cognitive or other barriers.
  Ability to lead an interdisciplinary care team.
  Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner.
  Comfortable with conducting home visits and commuting within the service area.
  Minimum 3 years' clinical experience with focus in managed care, including disease or case management.

  General Job Information

  Title

  Care Manager BH/RN, Remote in PA

  Grade

  25

  Work Experience - Required

  Clinical

  Work Experience - Preferred

  Education - Required

  Associate - Nursing

  Education - Preferred

  Bachelor's - Nursing

  License and Certifications - Required

  RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt

  License and Certifications - Preferred

  CCM - Certified Case Manager - Care MgmtCare Mgmt, CCP - Chronic Care Professional - Care MgmtCare Mgmt

  Salary Range

  Salary Minimum:

  $64,285

  Salary Maximum:

  $102,855

  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.

• About the company

  Magellan Health Inc., is an American for-profit managed health care company, focused on special populations, complete pharmacy benefits and other specialty areas of healthcare.

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