Under supervision of clinical leadership, the navigator is a phone queue based role responsible for answering calls from Magellan members, individual providers, facilities, and customer representatives. May provide utilization management review and authorization of behavioral health and substance use disorder services ranging from outpatient counseling to inpatient levels of care. May assist with connection to Employee Assistance Program (EAP) services including counseling, coaching, Critical Incident Response and Workplace Support Services (WPS). Responsible for triaging calls, determining level of risk, managing crisis calls, and assessing members for all types of risk following Magellan's established crisis call protocols. Navigator will be assigned additional responsibilities based on experience, including training and mentoring newly hired navigators.

• Manage EAP service requests within scope of clinical role including in the moment telephonic consultation, connection to EAP counseling, education and connection to other EAP benefits. Conduct risk assessment and assessment of social determinants of health needs on all calls. Provide WPS Supervisor Consultations, manage requests for Critical Incident Response, submit requests for urgent/routine member appointment searches.  (30%)
• Provide utlization management review and authorization of behavioral health and substance use disorder services ranging from outpatient to inpatient levels of care utilizing applicable Medical Necessity Critera (MNC) guidelines. Assist members and facilities in coordinating and accessing benefit eligible treatment.  (30%)
• Provide crisis call management. Follow crisis call protocols and connect to emergency services, mobile crisis response, and/or other crisis resources as appropriate. Outreach to members assessed as high risk. (20%)
• Assist members with accessing benefit eligible EAP, BH, or SUD treatment via bed searches and routine/urgent apointment searches. Manage requests and complete outreach for Critical Incident Response event staffing. (10%)
• When off queue, other responsibilities include completing required corporate and clinical trainings, participation in individual supervision and team meetings, gathering and submitting customer feedback, supporting Magellan holiday phone queue coverage and assisting with training/mentoring of new hires and existing staff.  (10%)

Other Job Requirements

Responsibilities

Full clinical licensure with master's degree in social work, counseling, or similar area; License must be active in state employee works/lives.
Minimum of 5 years' experience post-licensure in healthcare, behavioral health, social work, psychiatric and/or substance use disorder setting.
Strong organization, time management, and communication skills.
Registered Nurse (RN) licensure acceptable for existing staff; all new hires will need to be master's level licensed clinicians.
CEAP certification as required by management.
Knowledge of utilization management procedures, mental health, and substance abuse community resources and providers.
Knowledge of and experience in inpatient setting.
Knowledge of DSW V or most current diagnostic edition.
Ability to analyze specific utiliation problems and plan and implement solutions that directly influence quality of care.
Strong computer skills to utilize and navigate various systems.

General Job Information

Title

Sr. Clinical Care Navigator

Grade

26

Work Experience - Required

Behavioral Health, Care Management, Social Work

Work Experience - Preferred

Education - Required

Bachelor's - Nursing, Master's - Counseling, Master's - Social Work

Education - Preferred

License and Certifications - Required

LCMFT - Licensed Clinical Marriage and Family Therapist - Care Mgmt, LCSW-C - Licensed Certified Social Worker - Clinical - Care Mgmt, LCSW - Licensed Clinical Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Salary Range

Salary Minimum:

$70,715

Salary Maximum:

$113,145

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.