Clinical Case Manager – Transitions of Care – Behavioral Health

Clinical Case Manager – Transitions of Care – Behavioral Health

Requirements

• Must reside in Oklahoma
• Oklahoma-licensed mental health professional: Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT), Licensed Behavioral Practitioner (LBP), or Licensed Clinical Social Worker (LCSW) with current unencumbered license.
• 3+ years clinical practice experience (e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility)
• 2+ years of experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
• Must possess reliable transportation and be willing and able to travel in-state up to 30% of the time. Mileage is reimbursed per our company expense reimbursement policy.

Responsibilities

• Responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating).
• Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes.
• Responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all care management activities with members to evaluate the medical and behavioral health needs to facilitate the member’s overall wellness.
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
• Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
• Completes assessments taking into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and include the member’s restrictions/ limitations.
• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
• Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
• Applies and interprets applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
• Using holistic approach consults with manager, Medical Directors and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives.
• Presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.
• Works collaboratively with the members’ interdisciplinary care team.
• Identifies and escalates quality of care issues through established channels.
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
• 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.
• Analyzes utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Facilitates clinical hand offs during transitions of care.

Preferred Qualifications

• Experience providing care to diverse populations
• 1+ year(s) of crisis intervention experience
• Managed care/utilization review experience
• Case management and discharge planning experience