Company :Highmark Inc.
Job Description :
This job provides behavioral health case and condition management services to Highmark's pediatric members and their families. The incumbent uses clinical and motivational interviewing skills to assess members’ needs and establish mutually agreeable short and long-term goals. Supports members in developing self-management skills and adopting positive behavior changes, identifies and addresses barriers to member’s adherence to standards of evidence-based care, helps members to coordinate their healthcare services and navigate the healthcare system, and identifies on-line, telephonic and community-based resources. This is a pediatric focused position that will be working with our member population 17 and under and their families.
- Function as a primary contact for members with behavioral health needs with the depth of engagement ranging from coaching interventions to intensive case management interventions. The overall goal is to help members navigate the health care system and develop condition self-management skills through behavior change. Provide members with resources and tools to assist in health-related decision making. Conduct telephonic clinical and psycho-social assessments that address the health and wellness needs of the Organization's members.
- Develop case or condition-specific plans of care using the clinical information system to establish short and long-term goals. Establish a plan for regular telephonic contact with each member to review progress and assess the potential for additional needs.
- Communicate with the member’s treating provider or providers in more complex clinical situations requiring case management intervention.
- Identify on-line, telephonic and community-based resources that can assist the member to achieve and maintain their personal health goals and assists the member to access those services.
- Pro-actively incorporate lifestyle improvement and prevention opportunities into member interactions and coaching.
- Ensure that all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.
- Collaborate with case and condition management teams to provide co-management activities for members who require additional services. Participate in ongoing training and educational activities related to behavioral health and medical topics.
- Other duties as assigned or requested.
- High School Diploma/GED with RN license or Master's Degree if licensed Behavioral Health Professional
- If Registered Nurse (RN) should have BSN or MSN
- 3-5 years of post licensure experience in any combination of behavioral health clinical, case management and/or condition management.
- Pediatric experience and knowledge of spectrum disorders, eating disorders, ADHD, gender dysphoria, family systems and therapeutic resources
- Advanced training and experience in cognitive behavioral therapy (CBT) and motivational interviewing
- Experience working with the healthcare needs of diverse populations
- Proficiency in a second language
LICENSES AND CERTIFICATIONS
Any of the following:
- Registered Nurse (RN)
- Licensed Social Worker (LSW)
- Licensed Clinical Social Worker (LCSW)
- Licensed Professional Counselor (LPC)
- Licensed Marriage and Family Therapist (LMFT)
- Case Management Certification
- Proficiency in utilizing PC-based system application and reporting packages, especially Microsoft Office application
- Excellent verbal and written communication skills as well as the ability to manage multiple priorities in a rapidly changing environment
- High degree of organizational skills
- Ability to interact with group employer accounts and other stakeholders relative to behavioral health topics
- General understanding of employer-based and individual insurance products
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )
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