Job Description :
This job provides case and condition management services to members with behavioral health concerns. 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.
- 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
- 3-5 years of post licensure experience in any combination of behavioral health clinical, case management and/or condition management.
- If Registered Nurse (RN) should have BSN or MSN
- 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 position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Referral Bonus: Level 1
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