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Case Manager, Behavioral Health, Licensed Clinician

2 months ago

French Camp, United States Health Plan San Joaquin Full time
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

Summary

Under general direction, the Behavioral Health Case Manager, Licensed Clinician is responsible for providing intervention services to assist members and their families in coping with complex social problems that accompany medical and behavioral health conditions or inhibit recovery in a manner that supports quality, cost effective care, and is consistent with department objectives and applicable regulations. Work is varied and moderately complex and requires a moderate degree of discretion and independent judgment.

Supervises

  • None
Essential Functions
  • Conducts initial review for selected members, triages as appropriate.
  • Assesses psychosocial factors that may influence health or recovery for identified members.
  • Develops care plans in partnership with members, their provider, and plan staff.
  • Collaborates with members, family/caregiver, and internal and external resources to ensure understanding of and compliance with care plans.
  • Provides and coordinates resource contacts, and/or referrals to appropriate professional or community resources.
  • Monitors and evaluates progress at appropriate intervals; conducts appropriate interventions.
  • Assists RN case managers and concurrent review nurses with case management, discharge planning and other member transition needs.
  • Assists CM & CCRN in assessing members for Mental Health/Behavioral needs and refers to appropriate resources to meet needs.
  • Performs community outreach for selected members as assigned.
  • Supports and advises member on self-advocacy efforts.
  • Documents activities in appropriate plan system(s) according to standards; maintains records according to standards.
  • Tracks data as required; compiles data for, produces and submits routine reports.
Non-Essential Functions
  • Other duties as required.
Knowledge, Skills, Abilities and Competencies

Required
  • Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines.
  • Ability to apply clinical judgment to complex medical situations and make timely decisions.
  • Strong psychosocial assessment skills.
  • Strong knowledge of prevention, treatment and rehabilitation techniques used in the identification and treatment of mental illness and emotional disorders.
  • Strong knowledge of federal, state and local laws, rules and regulations associated with mental health treatment and education programs.
  • In depth understanding of the treatment of mental illness, including wellness and recovery as well as strength-based approaches for individuals and their families.
  • In depth knowledge of chronic and acute disease and how they impact health conditions and social functioning.
  • Strong knowledge of and proficient skills in administering protocols.
  • In-depth knowledge of community resources related to healthcare.
  • In-depth knowledge of medical policy benefits and exclusions.
  • Ability to read, interpret and apply complex written regulations, guidelines and other materials; ability to read and interpret basic clinical information.
  • Strong analytical and assessment skills.
  • Strong problem-solving skills.
  • Basic negotiation skills.
  • Produces work that is accurate and complete.
  • Produces the appropriate amount of work.
  • Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
  • Rebounds from setbacks and adversity when facing difficult situations.
  • Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
  • Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
  • Ability to use tact and diplomacy to diffuse emotional situations.
  • Strong oral and written communication skills, with the ability to communicate professionally to diverse individuals inside and outside of HPSJ, effectively explain complex information and document according to standards.
  • Strong customer service skills.
  • Ability to work independently and as part of a team.
  • Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines
  • Basic skills in Word and Excel.
  • Ability to enter data into and navigate through multiple databases.
  • Ability to speak and be understood in English.
  • Ability to handle confidential information with appropriate discretion.
Preferred
  • Proficient (as defined by HPSJ’s Cultural and Linguistics Program) in one of HPSJ’s threshold languages.
  • Basic knowledge of the principles, practices and regulatory requirements of managed care.
  • Knowledge of Medi-Cal or other government sponsored programs and regulations as they apply to social work.
Education and Experience

Required
  • Licensed Clinical Social Worker, Marriage and Family Therapist or Professional Clinical Counselor license; and
  • At least three years as a social worker in a health care setting.
Preferred
  • Experience working with Medi-Cal and other government sponsored programs.
  • Experience working in a managed care setting.
Licenses, Certifications

Required
  • Current Clinical Social Worker (LCSW) License, Marriage and Family Therapist (MFT) License, or Licensed Professional Clinical Counselor (LPCC) issued by the California State Board of Behavioral Science Examiners.
  • Valid California driver license and reliable transportation, or the ability to obtain transportation on demand in the counties served by the plan if prohibited from getting a driver license due to a medically documented disability.
Preferred
  • None.


We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.