Magellan Health

Manager

• Responsible for HEDIS and NCQA Accreditation
• Implements assigned quality program components
• Interfaces with customers and regulatory entities
• Manages day-to-day quality activities ensuring compliance
• Supervises quality staff to ensure project execution

Quality Manager

General

• Will train and coach Federal government/military personnel in individual or group settings to develop mental skills necessary for peak performance.
• Conduct individual and group assessments to include observation, data collection, interviews, and consultations with organizational leaders to customize programs for optimizing and sustaining high levels of performance.
• Attend staff meetings with interdisciplinary team members and government leadership to coordinate services aligned with organizational goals.
• Provide expert guidance on matters related to mental performance, exercise science, and sport psychology.
• Develop customized curriculum to support the human performance outcomes of the federal organization.

Cognitive Performance Specialist

Medical Reviewer

• Conducts reviews of clinical interactions and clinical documentation
• Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting
• Interacts with multiple stakeholders internally and externally
• Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse incidents related to clinical services
• Audits and reviews case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements
• Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for care managers
• Evaluates level of patient safety risk and need for follow-up actions per policies
• Prepares monthly performance reports with assistance from Reporting and Analytics unit
• Presents findings at provider and customer meetings as needed
• Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managers
• Responsible for auditing as well as validating internal audit results and/or corrective action plans

Quality Clinical Reviewer

Program Specialist

• Connect members with appropriate housing resources by gathering information, researching available programs, and maintaining up-to-date resource files
• Ensure accurate communication with members assisting with housing-related needs
• Build targeted resource lists and collaborate with community organizations
• Stay informed about housing policies and funding changes
• Respond to housing referrals by gathering detailed information about the member
• Research available housing programs and resources in the member's area and match them to appropriate programs
• Report weekly on referrals worked and consult with colleagues about complex situations
• Attend rounds to provide housing resources as needed
• Provide a curated list of housing resources to members and their Care Coordinators
• Update and maintain current housing resource files
• Build specific resource lists as concerns or trends arise
• Attend community events, meetings, and functions to collect additional resources and information about potential changes to relevant programs.

Housing Program Specialist

Counselor

• Provide coverage in short-term, surge and on demand situations.
• Provides the full breadth of Adult or Child and Youth Behavioral (CYB) counseling services.
• Work closely with the installation and military branch Points of Contact (POC).
• Provides non-medical, short term, solution focused, counseling.
• Services include assessment, brief counseling and consultation, action planning, referral to resources, and follow-up as indicated.

Assignment Readiness Counselor – Short Term or On Demand

Care Coordinator

• Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes.
• Duties are performed virtually or face-to-face based on contractual requirements.
• Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction.
• Assists with orientation and mentoring of new team members as appropriate.
• Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.
• Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
• Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (e.g., during transition to home care, backup plans, community-based services).
• Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.
• Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
• Acts as an advocate for member`s care needs by identifying and addressing gaps in care.
• Performs ongoing monitoring of the plan of care to evaluate effectiveness.
• Measures the effectiveness of interventions as identified in the members care plan.
• Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes.
• Collects clinical path variance data that indicates potential areas for improvement of case and services provided.
• Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.
• Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.
• Facilitates a team approach to the coordination and cost-effective delivery to quality care and services.
• Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long-term care services.
• Utilizes licensed care coordination staff as appropriate for complex cases.
• Provides assistance to members with questions and concerns regarding care, providers or delivery system.
• Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
• Generates reports in accordance with care coordination goal.

Care Coordinator – CISC

• Provide coverage in short-term, surge, and on-demand situations for military needs
• Deliver a full breadth of Adult or Child and Youth Behavioral counseling services
• Write activity data daily through smart phone or web application
• Collaborate closely with installation and military branch Points of Contact
• Provide assessment, brief counseling, and referral to resources
• Offer training and guidance to parents and staff
• Maintain confidentiality and anonymity of service / family member

Assignment Readiness Counselor – Short Term, On Demand

• Provide coverage in short-term, surge and on demand situations resulting from the Military needs such as a post-deployment event or to cover an existing assignment for counselors who are absent.
• Provides the full breadth of Adult or Child and Youth Behavioral (CYB) counseling services to military service members and their families at military installations.
• Services include non-medical counseling, training/health and wellness presentations, consultation with parents, personnel at child daycare centers and schools, and consultation to installation command regarding behavioral health issues affecting military personnel and their family members.
• Counselors work closely with the installation and military branch Points of Contact (POC) to assure that the program is provided within scope and meets the needs of the installation.
• Provides non-medical, short term, solution focused, counseling directly to adults, children, and youth of service members.
• Services include assessment, brief counseling and consultation, action planning, referral to resources (assuring linkage as appropriate), and follow-up as indicated.
• CYB counselors will also have a focus on supporting the staff and personnel of CDCs, DoDEA and community schools, youth programs and summer camps as well as providing parent training and guidance.
• Participates in health fairs and other base/installation activities. Enters counselor activity data daily through smart phone or web application assure that reporting is accurate from assigned installation while maintaining confidentiality and anonymity of service / family member.

Assignment Ready Counselor

Customer Support

• Customer advocate role supporting our members and providers, facilitating care and service
• Handling incoming/outgoing calls related to healthcare related benefits
• Administration of intake documentation into the appropriate systems
• Provide outstanding service to internal and external customers and strive to resolve callers’ needs on the first call
• Research medical information regarding a variety of services including: educating providers on claims, member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality
• Meet key performance indicators and service standards
• Identify and respond to crisis calls with appropriate resource
• Facilitate routine referrals and triage decisions not requiring clinical judgment
• Navigate Magellan’s systems, document customers' comments/information

Customer Experience Associate

Systems Engineer

• Act as a liaison between IT and business units across Magellan HealthCare (MHC)
• Work with end users to understand business definitions of data
• Gather technical and business specifications for projects
• Assist in assuring technical systems meet company data needs
• Translate requirements into specifications involving appropriate technologies
• Document various work processes
• Develop proof of concepts to demonstrate workflows and gain user/stakeholder buy-in
• Collaborate with business stakeholders, developers, and analysts to meet business needs
• Ensure data quality is maintained and identify data integration errors

Principal IT Analyst – Business Systems Analyst

• Develop and lead Magellan peer support programs
• Guide the role, knowledge, practice, and activities of peer support specialists
• Oversee research, planning, implementation, and monitoring of recovery support services
• Advocate for recovery and resiliency principles across the CMC and community
• Build partnerships to promote recovery, resiliency, and wellness
• Provide technical assistance and consultation regarding peer-run recovery services
• Conduct member focus groups for improvement opportunities
• Establish structures to increase member and family voice in services
• Administer and oversee pilot programs promoting peer-run recovery initiatives
• Support and train peer support specialists

Manager, Recovery and Resiliency Services

Program Manager

• Responsible for the daily operation of the assigned contract(s) providing program management, deliverable completion, team supervision, and report completion
• Acts as the on-site face to the customer
• Supports contract negotiations, contract renewals and RFP processes
• Develops strong relationships with key operational customers and stakeholders
• Acts as a single point of contact for the supported program
• Responsible for all contractual discussions and modifications
• Identifies areas of contract improvement and enhancement
• Manages the program budget and keeps the agency informed of program dollars spent
• Supervises staff including hiring and training responsibility
• Ensures that standards are being properly upheld and procedures executed

Director, Federal Program Management

• Responsible for the overall successful operation of assigned contract(s).
• Directs or leads others in directing successful contract program management, deliverable completion, team supervision, and report completion.
• Effectively builds client relationships, internal company and external partnerships and effectively engages employees.
• Ensures program staff are appropriately trained and understand all contract and company policies and procedures.
• Partners with resources to achieve business objectives, maintain contract satisfaction, and ensure that products and services support customer needs while achieving acceptable margins.
• Directs the full scope of one or more contracts in varying complexity ensuring staffing, excellence in operational contract performance to successfully meet contract deliverables on time and within budget.
• Develops strong relationships with employees, key operational customers, internal company, and external stakeholders.
• Identifies opportunities for contract improvement/enhancement ensuring best practices are identified, shared, and applied.
• Responsible for all contractual discussions and modifications ensuring ongoing contract success in meeting deliverable requirements, mitigating risk and identifying corrective action.
• Manages contract financial performance and variances keeping the company informed of risk.
• Manage to key metrics and performance indicators while mitigating risk and seeking opportunities for quality improvement.
• Ensures planning, execution and follow-up for key meetings and projects including management of staff responsible for project management.
• Oversees and actively partners with corporate functions for talent acquisition, recruitment, hiring, promotion, and performance management.
• Ensures organizational commitment to employee engagement and ensures adequate new staff training and orientation and ongoing professional development of existing staff.
• Ensures team’s adherence to company policies, procedures, and mandatory compliance training.
• Actively participates in Strategy and Growth activities, which may include developing solutions, proposals, staffing estimates, and/or new business opportunities, to promote business growth of existing and future work. All other duties and special projects as assigned.

Senior Director, Federal Program Management

Account Executive

• Manages day to day account relationship
• Supports development and ongoing strategy for retention and growth
• Develops relationships with internal partners to achieve strategic alignment
• Analyzes data and reporting for executive summaries

Account Executive – Behavioral Health

• Conducts reviews of clinical interactions and clinical documentation including reviews of case management records and provider treatment records.
• Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting.
• Interacts with multiple stakeholders internally and externally.
• Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse incidents related to clinical services.
• Audits and reviews case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements.
• Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for care managers.
• Evaluates level of patient safety risk and need for follow-up actions per policies.
• Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services.
• Prepares monthly performance reports with assistance from Reporting and Analytics unit.
• Presents findings at provider and customer meetings as needed.
• Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managers.
• Responsible for auditing as well as validating internal audit results and/or corrective action plans.