Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.4 million individuals, including Health Net's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company's website at
Care Manager is responsible for the implementing the Care Management programs in multiple environments including Prior Authorization, Concurrent Review and Care Management. A patient advocacy approach with a seamless integration of services is required and must be balanced within the member's benefit structure.
Emphasis will be placed on continuity of care, assisting members in obtaining access to care, and member education. Participates in the continuum of care that addresses the ongoing needs of the member served by the care management process.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Provides Intensive Case Management for Managed Care beneficiaries.
- Identifies patients appropriate for this service by evaluating high risk cases, intensity and complexity of services, health care costs, non-compliance issues and other triggers per policy.
- Manages cases to ensure that the beneficiaries' clinical needs are met at the most cost effective and clinically appropriate level.
- Coordinates care between multiple providers.
- Develops care plans in coordination with providers, patients, and families, as appropriate and assesses its effectiveness over time.
- Identifies Potential Quality Indicators using criteria established by the QM department.
- Coordinates with Medical Director when appropriate.
- Communicates with both internal and external customers. Educates providers, members and beneficiaries regarding benefits.
- Effectively analyzes complex cases; makes innovative use of available resources.
- Performs data entry of authorizations and review-related material.
- May act in a lead capacity.
LCSW, LPC, LMFT, Licensed Psychologist
Minimum two years case management or related experience.
Minimum three years psychiatric experience in acute, outpatient or Mental Health settings
Knowledge, Skills & Abilities:
- Demonstrated ability to assess, evaluate and integrate clinical data
- Computer literacy
- Ability to function professionally under pressure
- Self-starter with good problem solving skills
- Ability to function as a team with cooperation, flexibility and willingness to assist others
- Familiarity with Managed Care policies and procedures
- Knowledge of Managed Care benefits and eligibility in this program
- Familiarity with community resources
- Ability to identify Potential Quality Indicators using criteria established by the QM department
- Excellent planning, organizational and prioritization skills
- Demonstrated communication and interpersonal skills
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
Health Net - 2 years ago