Case Management

2 weeks ago

Oakland, United States Blue Shield of California Full time

Your Role

Reporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will offer support in assessing member’s emotional and psychological well-being and providing resource coordination, crisis intervention, substance abuse, and with any behavioral or mental health referrals. This role will be available to physicians and nurse care managers as a consultant for patients with complex psychosocial needs. Additionally, this role demands for an intensive focus on crisis intervention and counseling, problem-solving and conflict resolution, patient and family management, interdisciplinary collaboration, psychosocial assessments, education, advocacy, and community resource linkages.

Your Work

In this role, you will:

  • Collaborate with case managers and other team members to complete member assessments related to social and resource needs to support member access to services  
  • Collaborate with service coordination staff and act as liaison to ensure timely and accurate response to member needs 
  • Collaborate with providers to support members treatment plan and care needs 
  • Recognize the client’s right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team 
  • Assess members health behaviors, cultural influences, and clients belief/value system, and evaluate all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers 
  • Efficiently manage and maintain a caseload of members for behavioral health care coordination and or Behavioral Health case management for persons experiencing severe and persistent mental illness
  • Maintain an active workload in accordance with National Care Manager performance standards
  • Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures and criteria
  • Interact with Utilization department and Physician Advisors to discuss clinical questions and concerns regarding specific cases 
  • Coordinate services with state and community programs on behalf of the member, particularly when the member is unable to effectively do so independently
  • File and follow up (as a mandated reporter) on reports made to the appropriate government agency (e.g., Adult Protective Services, Child Protective Services, etc.)
  • Actively participate in Interdisciplinary Team Meetings and case consultations with Licensed Manager)

Your Knowledge and Experience

  • Requires a current CA RN License. LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences
  • Requires moderate to extensive experience in nursing, health care or related field
  • Requires 5+ years’ experience in nursing, health care or related field
  • Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field is required
  • Managed Care experience of at least 3 years is preferred
  • Advanced degree is preferred commensurate with field 
  • Experience conducting thorough psychosocial assessments, developing care plans and providing necessary interventions identified during assessment with complex client populations that may have, among other things, inadequate coping skills, severe emotional disorders, developmental disabilities, mental illnesses, and/or unstable housing is preferred
  • Considerable knowledge of a wide range of psychosocial challenges and familiarity with behavioral health diagnoses and treatment is preferred
  • Proficiency with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint is preferred

Pay Range:

The pay range for this role is: $77,990.00 to $116,930.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

 

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