Magellan Health is the leader in managing complex population health, concentrating on all areas across healthcare and pharmaceutical management.
 
At Magellan Health, 10,000 people wake up every day determined to help our members. We do this by connecting behavioral, physical, pharmacy and social needs into a complete picture of care that’s personalized, coordinated and cost-effective. By turning fragmented care into focused care, we empower 1 in 10 Americans to lead healthier, more vibrant lives.
Magellan Health Remote
Apr 10, 2021
Physician
Currently seeking hours of coverage Monday-Friday 7am-7pm CST. Friday commitment is a preferred. Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Directs daily involvement in the following utilization management functions: Reviews all cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request by phone or fax. Provides clinical rationale for standard and expedited appeals. Provides assistance and act as a resource to Initial Clinical Reviewers as needed to discuss cases and...
Magellan Health Remote
Mar 25, 2021
Mental Health Therapist Licensed Clinical Social Worker
The work schedule for this opening is: Tuesday-Saturday 3pm-11pm Central Time Candidates must hold an independent-level Social Work or Behavioral Health license in the state they live in/work in (LCSW, LMFT, LMHC, LPC, etc.) 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. 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...
Magellan Health Remote
Mar 24, 2021
Physician
Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Directs daily involvement in the utilization management functions. Reviews all cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax. Provides clinical rationale for standard and expedited initial determinations and/or appeals. Provides assistance and act as a resource to Initial Clinical Reviewers as needed to discuss cases and problems. Utilizes medical/clinical review guidelines and parameters to assure...