RN or LCSW Behavioral Health Case Manager – Health Plan
Behavioral Health Case Manager Job Summary:
Assesses, plans, implements, monitors and evaluates options and services to meet complex psychosocial health needs of inpatient and outpatient members. Manages a caseload in compliance with contractual obligations and standards.
Conducts comprehensive member assessments through root cause analysis based on referred member's needs and benefit plan eligibility, and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs.
Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Works towards achievement of optimal clinical and resource outcomes.
Monitors and evaluates effectiveness of care plan and modifies plan as needed. Supports member access to appropriate quality and cost-effective care. Coordinates with internal and external resources to meet identified needs of the member's care plan and collaborates with providers.
Acts as a liaison and member advocate between the member/family, physician and facilities/agencies. Provides clinical consultation to physicians, professional staff and other teams members/supervisors to provide optimal quality patient care and effective operations.
Interacts continuously with members, family, physician(s), and other resources to determine appropriate behavioral action needed to address medical needs. Reviews benefits options, researches community resources, trains/creates behavioral routines and enables members to be active participants in their own healthcare.
Ensures members are engaging with their PCP to complete their care management treatment plan or preventive care services.
Behavioral Health Case Manager Background Profile:
Requires a valid, unrestricted state license as Registered Nurse (R.N.) with a behavioral health background, OR unrestricted state license as Licensed Clinical Social Worker (L.C.S.W.)
Requires 2-3 years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning.
At least 1 year of experience in case management as a licensed professional.
Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs is required
Prefer Behavioral Health / Mental Health Case Management experience from a Health Plan, IPA, HMO, or other Managed Care setting.
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.