Care Manager

Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or outpatient care settings. Collects and analyzes utilization data. Assists with discharge planning and care coordination. Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects.
This position is located on-site in the Newtown, PA office.
- Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
- Provides telephone triage, crisis intervention and emergency authorizations as assigned.
- Performs concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience. In conjunction with providers and facilities, may develop discharge plans and oversee their implementation. May also perform quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.
- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
- Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.
- Participates in quality improvement activities, including data collection, tracking, and analysis.
- Maintains an active work load in accordance with National Care Manager performance standards. Works with community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. Participates in network development including identification and recruitment of quality providers as needed. Advocates for the patient to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process.
Minimum Requirements:
-PA licensed behavioral health professional
- Master's degree in behavioral health filed
-Two year's behavioral health work experience.

General Job Information



Care Manager



Job Family

Clinical Services Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Minimum Qualifications


Associates Nursing--&& Bachelors Social Work--&& Masters Social Work

License and Certifications - Required

CEAP - Certified Employee Assistance Professional - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements


  • 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:┬  CEAP, LMSW, LCSW, LPC, RN or LPN.

  • Minimum 2 years experience post degree in healthcare, behavioral health, psychiatric and/or substance abuse health care setting.

  • Strong organization, time management and communication skills.

  • 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.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.

More Jobs

Care Manager, Telephonic Nurse 2 - Humana Gove...
Home, PA Humana Inc.
Mobile Care Manager/Licensed Masters Therapist
Reading, PA Tower Health
Care Manager, Telephonic Nurse 2 - Pediatric S...
Home, PA Humana Inc.
RN Case Manager Outpatient - PSHMG Care Manage...
Hershey, PA Penn State Milton S. Hershey Medical Center
Care Management Associate
Philadelphia, PA Aetna
Care Management Associate
Cranberry, PA Aetna