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Come join us and be part of a purpose driven company who is invested in your future!Job Summary This Position Is Responsible For Performing Behavioral Health Case Management In Accordance With Accepted Department Criteria. Consulting With Physicians, Providers, Members, And Other Resources To Assess, Plan, Facilitate, Coordinate, Monitor, Evaluate, And Advocate Options And Services Required To Meet An Individual And Family Comprehensive Health Needs. Using Communication And Available Resources To Promote Quality, Cost Effective Outcomes; Serving As Liaison To Providers, Physicians, And Members.
Responsibilities The Case Manager facilitates communication and coordination among all members of the health care team, by involving the member in the decision making process. The case manager will provide information to the patient and all members of the health care delivery team to the extent reasonably necessary to permit them to make informed decisions. At a minimum, the information provided about Case Management (CM) services will include: the CM process, community resources, possible insurance benefits, significant risks, alternatives, cost factors and the right to refuse CM services. Perform additional ongoing functions to support the Care Management Department, including more than one of the following: Enroll participants and perform case management activities according to department enrollment criteria and policies for case management identification, assessment, care plan development, documentation, evaluation, and consultation. Consult with physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implementation, coordinate, monitor and evaluate options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost effective outcomes. Use professional judgment and departmental guidelines to refer cases for chronic and catastrophic review and to physician reviewers. Develop alternate plans and assist members/providers to navigate the health care system optimizing benefits. Refer care options to contracted providers. Provide accurate and timely review of clinical information provided verbally (telephonically) or written (for retrospective reviews). Utilize knowledge of behavioral health diagnoses and related criteria (DSM-IV or ICD 10) as assigned. Assess cases for quality of care and refer cases to the physician reviewers for review and follow up. Cooperate with other members of the department and interfacing departments as a team to decrease costs, coordinate benefits, and provider services by promoting quality of care to subscribers. Participate as preceptor for orientation of new employees. Maintain and enhance knowledge of behavioral health practitioner and regulatory standards by attending seminars, training sessions, etc. Perform Behavioral Health Case Management services. Practice within the scope of licensure in accordance with URAC and NCQA accreditation standards and regulations. Must maintain licensure. Required Job Qualifications: Registered Nurse (RN) OR Masters-level Behavioral Health Professional or Doctoral degree in a Behavioral Health field (LCSW, LPC, LMFT, Licensed PhD Psychologist) with a license to practice at the independent level in this field. Current, valid, unrestricted clinical license in state of operations. 2 years clinical experience of direct clinical care to the consumer. Utilization management, discharge planning or managed care experience. Customer service oriented. PC and database experience. Verbal and written communication skills. Preferred Job Qualifications: Case Management Certification (CCM). 3 years clinical practice experience. Familiarity with ancillary services, for example, wellness or community-based programs (housing, family support services). Provider side insurance experience. Familiarity with Utilization Management or Case Management activities and standardized criteria sets. Bilingual in English/Spanish or English/Polish
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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