Magellan Health Services • Radford, VA and 5 other locations
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.
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.
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.
Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most cost effective setting.
Analyzes monthly financial results, conducts periodic forecasts of current year profitability and develops the annual budget for all assigned customers. Participates in periodic meetings with internal stakeholders to discuss results and develop corrective action plans to mitigate risk and optimize profitability.
Work with various teams across the enterprise to gain insights into product features and functions so that an Analytics roadmap can continue to evolve based on the portfolio of Magellan offered capabilities.
Develops and annually updates a formal written compliance program for the assigned Care Center, and educates the Care Center management team and staff about compliance and the appropriate details of the compliance program.
Define materials and communication events needed to support the segments value proposition in a manner that will influence all constituencies. Ensure that all positioning is optimized for intended segment.
Develops and maintains strategic and tactical approaches to relating to high-impact providers in the network that will distinguish the company in the industry and result in peak provider satisfaction and network stability.