Behavioral Case Manager - Health Plan

Location: New Orleans, LA
Date Posted: 02-01-2018
Case Manager (LCSW/LMFT/LMHC or RN) - Behavioral Health Managed Care​
New Orleans, LA
Job Summary:
As a member of the medical management team, the Behavioral Health Case Manager works with members, providers and caregivers to provide intensive, comprehensive case management and increase efficient utilization of services; identifies chronic or catastrophic cases through the case management process and initiates intensive case management according to program guidelines. The goal of the Behavioral Health Case Manager is to effectively manage patients on an outpatient basis to assure the appropriate level-of-care is provided, to prevent inpatient re-admissions and ensure that the patients’ medical, environmental and psychosocial needs are met over the continuum of care.  The Behavioral Health Case Manager also acts as an advocate for members and their families linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward a maximum level of independence.
Position Description:
The Behavioral Health Case Manager will interact with members both telephonically and in person in order to serve the daily case management needs of members. This includes administering all provider resources through the care continuum, from the initial referral through discharge and ensuring compliance with the plan of care. They will collaborate effectively with an interdisciplinary team to establish an individualized plan of care for members. A strong emphasis is placed on Wellness, Disease Management and patient/member education to ensure compliance with the plan of care and prevention of complications with various ailments and chronic conditions. The Case Manager will develop interventions and processes to assist the Health Plan member in meeting short and long term plan of care goals.  They will coordinate member visits with PCP and specialists as needed. Communication of patient needs will be conducted through timely and accurate data entry into designated care management applications. The Behavioral Health Case Manager will participate in the development of appropriate QI processes, establishing and monitoring indicators. Utilizing their knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms, the Nurse will help guide physicians in their awareness of preferred contracts, providers, and facilities. They will coordinate the approved services with all provider staff under the specific direction of the Medical Director or Manager of Medical Management.
Background Profile:
Requires a master's degree prepared individual with valid and unrestricted state licensure as a Licensed Clinical Social Work (L.C.S.W.), a Licensed Marriage and Family Therapist (L.M.F.T.), or a Licensed Mental Health Counselor (L.M.H.C.), with established behavioral health experience.
Will consider Registered Nurses (R.N.) that have extensive psychiatric/ behavioral health case management experience.
Certification in Case Management (CCM) is a plus.
At least 3-5 years Behavioral Health / Mental Health Case Management / Utilization Review experience, preferably in a Health Plan, IPA, HMO, or other payer setting.
Around 1-3 years’ experience in a Managed Care Organization (Health Plan/HMO/MSO/TPA/IPA/etc).
Requires strong working knowledge of utilization review procedures, and familiarity with area mental health community resources.
Intermediate computer literacy (MS Office) and typing skills are necessary.
Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
The Reward:
Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members.  The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance member’s ability to manage their own health.
Mike Vega
Search Consultant

CareNational Healthcare Services

480-264-0620 (CALL – TEXT – FAX)
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