Behaviour Health Case Manager
This Role is Fully Remote For Hawai State Only
Duration : 3+ Months (Temp to Perm)
Shift : 1st Shift , Monday to Friday
Job Summary
The Case Manager provides comprehensive case management services to TRICARE beneficiaries. This role involves screening referrals, conducting assessments, developing individualized care plans, and monitoring outcomes.
The Case Manager ensures compliance with HIPAA regulations, URAC standards, and TRICARE policies while advocating for beneficiary access to necessary care.
Key Responsibilities
- Case Management : Screen referrals and perform comprehensive assessments. Develop and implement individualized care plans, reassess monthly, and adjust as needed.
- Compliance & Reporting : Ensure compliance with HIPAA, URAC standards, and TRICARE policies. Document case management processes and outcomes.
- Beneficiary Advocacy : Facilitate access to specialized services, provide TRICARE and community resource information, and support care plan goals.
- Communication : Collaborate with Primary Care Managers or Behavioral Health providers. Present high-profile cases to the Medical Director as needed.
- Supervision : Provide direction to non-clinical staff.
Required Qualifications
- Licensure : Current, unrestricted state license as a Licensed Clinical Social Worker, Registered Nurse, or Clinical Psychologist.
- Experience : Minimum of 2 years of full-time direct clinical care experience.
- Certification : Ability to obtain a URAC-recognized certification in case management within 4 years of hire.
- Background Check : Must pass a Department of Defense (DOD) background investigation.
- Citizenship : U.S. Citizenship required.
Preferred Qualifications
- 2 years of case management experience.
- URAC-recognized case manager certification.
Competencies
Technical Skills : Proficiency in Case Management, TRICARE policies, HIPAA, URAC standards, and medical management systems.
Familiarity with InterQual ISD® criteria and medical coding.
- Problem Solving : Ability to analyze issues systematically and propose practical solutions.
- Organizational Skills : Expertise in task coordination, time management, and adjusting to changing priorities.
- Communication : Strong interpersonal skills with the ability to influence, listen, and adapt communication styles effectively.
- Computer Literacy : Proficient in Microsoft Word, Outlook, and departmental-specific software.
Additional Details
Geographic Hiring : Roles are available across T5 territory, covering 26 states. Candidates are primarily sought from CST-PST time zones.
CST candidates must be available to work 9 : 30 AM - 6 : 00 PM.
Candidates in Alaska and Hawaii are also encouraged to apply. Exceptional candidates from EST may be considered if they can work 10 : 00 AM - 6 : 30 PM.
Working Conditions
- Standard office environment with minimal travel required.
- Extensive computer uses with long periods of sitting.
- Availability to cover any work shift.
- Department of Defense security clearance required.
RN Case Manager
Description: Job Title: Home Care RN Case Manager Position Type: Exempt Reports to: Clinical Practice Manager GENERAL SUMMARY Provides, coordinates, and directs the provision of home health nursing services and case management processes according to the assigned patient's individualized plan of care...
Nurse Case Manager - Inpatient Rehab
The Nurse Case Manager collaborates with other members of the case management and health care teams, utilizes professional nursing skills to: assist the patient in achieving optimal health; assure appropriate use of health care resources; facilitate/coordinate timely care along the continuum; decrea...
RN Case Manager
Description: Job Title: Home Care RN Case Manager Position Type: Exempt Reports to: Clinical Practice Manager GENERAL SUMMARY Provides, coordinates, and directs the provision of home health nursing services and case management processes according to the assigned patient's individualized plan of care...
RN Case Manager, Home Health
As a Home Health RN Case Manager, you will:. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and soci...
Case Manager RN (Remote)
Collaborates with supervisor and other key stakeholders in the member's healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your he...
Complex Case Manager RN - Oncology (Remote)
In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent conducts outreach to members enrolled in case management including but is not limited to: dev...
RN Case Manager, Home Health
As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. Reviews availabl...
Case Manager (Clubhouse MH)
Highland Rivers is seeking a Case Manager for the Bright Changes Clubhouse in Cobb County. There is a place for you at Highland Rivers Behavioral Health!Highland Rivers provides treatment and recovery services to individuals impacted by mental illness; substance use disorders and intellectual develo...
Nurse Case Manager - Inpatient Rehab
The Nurse Case Manager collaborates with other members of the case management and health care teams, utilizes professional nursing skills to: assist the patient in achieving optimal health; assure appropriate use of health care resources; facilitate/coordinate timely care along the continuum; decrea...
Foster Care Case Manager
The Foster Care Case Manager works under the supervision of the Program Manager. The Foster Care Case Manager assists the Program Manager in developing individual treatment plans for troubled children and their families. The Foster Care Case Manager uses standardized tools to measure social and emot...