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Clinical - Behavioral Health Care
1 month ago
Location: This is a member facing/Remote role, where you will be meeting with members in their Homes or facilities 80% of the time. we are Looking for candidates located in cities that are located in the Hidalgo County and Starr County areas
Job Description: Position Purpose: Conducts comprehensive member psychosocial assessments through root cause analysis and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs. Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Assess members to recommend activities and behavioral routines to meet the social and medical needs of members and their families. Provides support and/or intervention and assists members in understanding the implications and complexities of their current medical situation and/or overall personal care. Candidate Education: Required A Master's Degree in Social Work, Psychology, Counseling, Rehabilitation, or other relevant field that provides a foundation to receive a license as required of the position Candidate Experience: Required 2+ years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning
Required 1+ year of experience in current case management as a licensed professional
Required Other Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Preferred Other Experience in a managed care environment
Required 5+ years of experience in For KY SKY Program: candidates must have 5 years of behavioral health care experience
Licenses and Certifications: A license in one of the following is required: Required Other A master's level independent or non-independent license is required OR an RN with a behavioral health background:
Required Licensed Registered Nurse (RN)
Required Licensed Clinical Social Worker (LCSW)
Required Licensed Clinical Mental Health Counselor (LCMHC)
Required Licensed Clinical Professional Counselor (LCPC)
Required Licensed Clinical Marriage & Family Therapist (LCMFT)
Required Licensed Clinical Psychologist (LCP)
Required Licensed Master Social Work (LMSW)
Required Certified Social Worker (C-SW)
Required Acute Care Nurse Practitioner (APRN) (ACNP-BC)
Required Other In New Jersey, one of the following is Required: Licensed Clinical Social Worker (LSW), Licensed Associate Counselor (LAC) or Registered Nurse (RN). Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC) Preferred.
Essential Functions: * Assesses, plans, implements, monitors and evaluates options and services to meet complex psychosocial health needs of inpatient and outpatient members. Manages a caseload in compliance with contractual obligations and WellCare standards.
* Conducts comprehensive member assessments through root cause analysis based on referred member's needs and benefit plan eligibility, and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs.
* Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Works towards achievement of optimal clinical and resource outcomes.
* Monitors and evaluates effectiveness of care plan and modifies plan as needed. Supports member access to appropriate quality and cost effective care. Coordinates with internal and external resources to meet identified needs of the member's care plan and collaborates with providers.
* Acts as a liaison and member advocate between the member/family, physician and facilities/agencies. Provides clinical consultation to physicians, professional staff and other teams members/supervisors to provide optimal quality patient care and effective operations.
* Interacts continuously with members, family, physician(s), and other resources to determine appropriate behavioral action needed to address medical needs. Reviews benefits options, researches community resources, trains/creates behavioral routines and enables members to be active participants in their own healthcare.
* Ensures members are engaging with their PCP to complete their care management treatment plan or preventive care services.
* Assists in obtaining benefits for members through community resources when benefits are exhausted or not available.
* Performs other duties as assigned. Additional Responsibilities: * In Hawaii, Registered Nurses may monitor the effect of medications, provide medication administration and education as needed under guidance of the Psychiatrist. The may provide education and clinical care for medical conditions and assists the Psychiatrist with member adherence to medications.
* Incumbents engaged in Florida's SMI program will manage members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Incumbents will travel extensively to member's inpatient bedside, home or other facility. Walk me through the day to day responsibilities of this the role and a description of the project:
- Perform duties related to the day-to-day operations of the Service Management functions for Star Kids members to achieve the highest possible levels of functioning and wellness by ensuring consistent, timely access to medically necessary behavioral health services. Monitor quality of care, assist with discharge planning.
- Provide service coordination to members and parents to meet the behavioral healthcare needs of each member's condition.
- Provide service coordination to members including assisting with access to medically necessary behavioral health services. Conducted assessments, developed, and implemented individual care service plans.
- Conduct in-home face to face member assessments and telephonic outreach assessments.
Describe the performance expectations/metrics for this individual and their team:
- Team member will be expected to adhere to turn around times set forth by the state in regard to completing in person assessments, telephonic assessments, completing documentation and conducting the contractual calls determined by member's level of care.They will also be expected to present themselves in a professional manner when interacting with families and collateral contacts.
- The first day consist of onboarding which includes meeting with the manager via phone, setting up technology, and obtaining access to the systems.
- Team member needs a solid background in behavioral health and must have a clean, unrestricted license such as; LPC, RN, LMFT, LCSW, etc.
