Psychiatric Residential Treatment Facility (PRTF) Care Manager - BH

Company: Magellan Health
Location: Washington
Posted on: June 2, 2025

Job Description:

--- 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, develops discharge plans and oversees their implementation.--- Performs 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, company policies, 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 workload in accordance with National Care Manager performance standards.--- Works with community agencies as appropriate and proposes alternative treatment plans when requests 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, interacting professionally and respectfully with providers to facilitate the treatment process.--- Serves as the primary point of contact throughout the treatment episode at the levels of care.--- Maintains a caseload of members enrolled in the case management program, including risk stratification, monitoring reassessment needs, and facilitating transitions of care settings.--- Ensures timely, complete, and accurate documentation in compliance with regulatory policies and procedures.--- Coordinates with the interdisciplinary team of providers, vendors, facilities, discharge planners, nurses, social workers, care coordinators, and members/caregivers to effectively manage care plans and transitions.--- Participates in complex case rounds and/or meetings, consulting regularly with Physician Adviser/Medical Director on member progress.
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Keywords: Magellan Health, Washington DC , Psychiatric Residential Treatment Facility (PRTF) Care Manager - BH, Executive , Washington, DC