This position will be internal auditing and quality oversight over clinical functions in California. Candidates must be licensed and reside in CA and this is a remote/work from home position.
Performs site visits to physicians (primarily Accountable Care Organization (ACO)/Independent Practice Association (IPA) Primary Care Physicians) to provide education on behavioral health topics/issues to improve member outcomes. Provide on-going support to these physicians – including information on mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Healthcare Associated Infections - California (HAI-CA) Medical Necessity Criteria, Clinical Practice Guidelines, Technology Assessments and Prevention Programs.
- Facilitate referrals to HAI-CA’s clinical programs or behavioral health network as clinically indicated. Provide feedback internally on issues identified and provide suggestions for resolution. Create and track action plans.
- Collaborate with the health plan’s Provider Relations team to support the implementation of any behavioral health education initiatives they have involving their physicians. Represent HAI-CA in meetings (physician-behavioral health related) at the customer’s site. Including, but not limited to, Network, QI, UM, and DVOD meetings.
- Track agenda and follow up issues log and interact with clinical team on Physician Liaison program status as well as functioning as administrative/clinical resource as appropriate.
- Build and maintain relationships at all levels within HAI-CA. Interact with HAI-CA CMC Chief Clinical Officer, Medical Director and Associate Medical Director, Physician Advisors or Chief Medical Officer for Behavioral Health to discuss clinical questions and concerns related to physician issues.
- Participate in CMC and SBU activities – including attending meetings and participation in projects as needed. Monitor data analysis and outcomes and report results internally and to the customer.
- Under the general supervision of the HAI-CA CMC Chief Clinical Officer, and in collaboration with the other members of the clinical team, reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care settings; collects and analyzes utilization data; under the direction of the supervisor or Medical Director, assists with discharge planning and ambulatory follow up activity; provides member assistance with mental health and substance abuse issues, and participates in special QI projects.
- Design and conduct presentations to ACO/IPA medical groups over behavioral health topics, in partnership with health plan's integration liaison.
- Monitor and respond to ACO/IPA phone line, to help coordinate integrated care for members, as well as track integration activities to report to health plan.
- Attend meetings with client, ACO/IPA groups, and/or internal Account Management, Network, and CMC leadership staff to track and develop the clinical integration program.
- Project manage new initiatives/pilot programs with client and ACO/IPA medical groups.
Other Job Requirements
Responsibilities
One or more of the following licenses: LCSW, LMFT, LPCC or PSY.
Strong organization, time management and written/verbal communication skills.
Knowledge of mental health and substance abuse community resources and providers.
Ability to function independently and as a team member.
Knowledge of DSM 5.
Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care; experience in Network and/or Provider Relations managed care work a plus.
Working knowledge of Microsoft Office Product Suite; ability and willingness to learn new computer software/systems.
General Job Information
Title
Clinical Integration Liaison - Licensed/Remote in California
Grade
24
Work Experience - Required
Clinical, Managed Healthcare
Work Experience - Preferred
Education - Required
Master's - Behavioral Health
Education - Preferred
License and Certifications - Required
LCSW - Licensed Clinical Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, PSY - Psychologist - Care Mgmt
License and Certifications - Preferred
Salary Range
Salary Minimum:
$58,440
Salary Maximum:
$93,500
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.
