Analyst Case Manager

Analyst Case Manager

Requirements

• 2 years’ experience in behavioral health, social services, or appropriate related field equivalent to program focus
• West Virginia resident residing in one of the following counties: Randolph, Tucker, Preston, Pendleton, Grant, Hardy, Hampshire, Mineral, Berkeley, Jefferson, and Morgan
• Must possess reliable transportation and be willing and able to travel in the assigned region 50% or more of the time
• 2+ years of experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams)

Responsibilities

• Conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate
• Coordinates and implements assigned care plan activities and monitors care plan progress
• Consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes
• Identifies and escalates quality of care issues through established channels
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
• Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
• Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
• Helps member actively and knowledgably participate with their provider in healthcare decision-making
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Preferred Qualifications

• Medicaid experience
• Waiver experience
• Foster care experience
• Crisis intervention skills
• Managed care/utilization review experience
• Case management and discharge planning experience
• Familiarity with QuickBase