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Behavioral Health Care Manager

Behavioral Health Care Manager

EPITECChicago, IL, United States
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Position : Care Management Specialist

Compensation : $39 / hr

Location : This is remote, visiting members (one in Chicago and one Rockford); training will require some onsite days

Job Type : 3-month W2 contract with the potential to be extended or converted to direct

BASIC FUNCTION :

  • This position is responsible for discharge care coordination, episodic case management and pre-admission / post-discharge counseling for an acute condition.
  • This position is responsible for handling duties in an independent manner and may assist other staff.
  • Establish relationship with the member through the immediate post discharge follow-up period or until all short-term care needs are met.
  • Provide education / local resource information and encourage member (self) education.
  • Determine case complexity and refer to other internal departments as needed.

ESSENTIAL FUNCTIONS :

  • Discharge care coordination, episodic case management and pre-admission / post discharge counseling and identification of alternate treatment options.
  • Consult with physicians, providers, members, and other resources, as appropriate.
  • Personalize outreach / engagement based upon attitudes / behaviors / risk assessment. Outreach to provider to coordinate the member's care or to notify of risks / new conditions.
  • Reconcile, educate and monitor adherence to medication safety.
  • Reinforce provider post-operative instructions for care, diet, activity level etc.
  • Address barriers to keeping follow-up appointments with appropriate provider and assistance with appointment scheduling. f. Assistance finding a primary or specialist provider, a Blue Distinction Center or any needed coordination with Customer Service.
  • Assist with getting to a provider if needed when all other options have been exhausted.
  • Referral to other BCC programs, or external resources community-based organizations, transportation, home health etc.
  • Provide on-site face to face intervention in select cases.
  • Education and recommendations to resolve conditions and risks, and support for behavior change / self-management.
  • Collaborate with the provider and member when appropriate to develop alternate plans of care if needed.
  • Assist members / providers to navigate the health care system. m. Assess cases for quality-of-care issues and refer cases to the QA / QI department for review and follow up.
  • Perform Transition of Care services for all assigned lines of business.
  • Determine case complexity and may refer to Case Management / Disease Management / Enterprise Lifestyle Management department personnel as necessary.
  • Practice within the scope of licensure.
  • Participate as preceptor for orientation of new employees.
  • Maintain licensure and maintain and enhance knowledge for designated area of licensure and regulatory standards by attending seminars, training sessions, etc.
  • Communicate and interact effectively and professionally with co-workers, management, customers, etc.
  • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
  • Maintain complete confidentiality of company business.
  • Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

    • REQUIREMENTS :

  • Registered Nurse (RN) or Licensed Master Social Worker (LMSW) with current, active, unrestricted license in the state of operations (or reciprocity if applicable).
  • 2 years clinical experience.
  • 1 year health insurance / managed care experience.
  • Knowledge of medical management policies and procedures.
  • PC and database experience.
  • Verbal and written communication skills.
  • Customer service skills and interpersonal skills to discuss pre / post admission care with physicians, hospital staff and members.
  • Ability and willingness to occasionally travel within assigned location. Possess transportation and current, valid driver's license for applicable state.
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    Behavioral Health Manager • Chicago, IL, United States