Behavioral Health Case Manager
Job ID 2012-20953 # Positions 1
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 10/15/2012
Additional Locations ..
More information about this job:
Responsible for managing members experiencing complex or catastrophic illness, high risk pregnancy, injury and/or specialty illnesses such as diabetes, HIV, transplant, behavioral health conditions, etc., to ensure cost effective and efficient utilization of health services. Conducts continuous skills assessment, planning, implementation, coordination, monitoring and evaluation.
1. Obtains an accurate member history, conducts an assessment of biopsychosocial factors, and assesses clinical information to develop care plans including a member support system.
2. Establishes prioritized short and long term goals in collaboration with the member that meet the member’s needs and the referral source’s requirements.
3. Establishes working relationships with referral sources and community resources.
4. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.
5. Collaborates with the member’s PCP and specialists in the development of the plan of care to ensure that members’ physical needs are addressed; communicates care objectives to appropriate individuals/departments/referral sources.
6. Provide case management and/or disease management services to members, as identified by a health plan’s referral process.
7. May be required to conduct field visits.
8. May be required to perform service authorization duties using prescribed criteria and responsibilities as assigned and required by the Plan
9. Acts as an advocate for an individual’s health care needs.
10. Reviews benefit systems and cost benefit analysis; evaluates the quality and necessity of applicable services; identifies members that would benefit from an alternative level of care; acquires data and evaluates necessary health services for cost containment; documents effectiveness of case management services
11. Participates in Quality Improvement processes and serves on internal and external committees as required.
12. Other duties as requested or assigned.
EDUCATION AND EXPERIENCE
- Nursing Diploma
- Associate’s Degree in related Health/Nursing field
- Bachelor’s or Master’s Degree in related Health/Nursing field
Years and Type of Experience Required:
- Minimum of three years clinically related experience
- Experience working on the community level and with community agencies
- Experience in managed care, case management and discharge planning
Certifications or Licensures
- Active licensed LPN/LVN, LSW or LCSW, LMSW, LMHC, LPC, NP, PA as required by state contract
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area
- Certified Case Manager
- Bilingual Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with utilization management data systems
- Demonstration of cultural competency by exhibiting keen awareness of cross cultural values and beliefs, acceptance of the dynamics that result from cultural differences and works to create an atmosphere of acceptance, civility, and respect towards all populations.
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
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