Behavioral Health Case Manager RN

3 weeks ago

Nashville, Tennessee, United States Lucent Health Solutions LLC Full time
Job Description

About Lucent Health Solutions LLC

We are a leading provider of care management solutions that combine top-tier claims management with a compassionate, human-focused approach. Our goal is to help self-insured employers provide cost-effective care management that enables health plan participants to make informed decisions.

Our company culture is built on honesty, ethics, and hard work. We believe that these values are the foundation of our success.

Honesty

  • We value transparent communication and ensure that all interactions are open and clear.
  • We prioritize integrity and accuracy in all our work outputs and tasks.
  • We provide honest feedback and report any issues or challenges as they arise.
  • We build and maintain trust by consistently demonstrating reliable behavior.

Ethics

  • We ensure that all actions and decisions respect our company policies and values.
  • We take ownership of mistakes and take responsibility for rectifying them.
  • We treat colleagues, clients, and partners with fairness and dignity.
  • We safeguard sensitive information and avoid conflicts of interest.

Hard Work

  • We meet or exceed deadlines and maintain high productivity levels.
  • We take initiative to tackle challenges without waiting to be asked.
  • We voluntarily offer to assist in additional projects or tasks when needed.
  • We work efficiently under pressure or in changing environments.

Behavioral Health Case Manager

Summary

Planning and Coordination

  • We create individualized plans of action based on assessments, facilitating the coordination of necessary treatment and services.
  • We consider benefit plan design and coverage options when developing plans.
  • We provide patients with information to make informed decisions, empowering them to make their own choices.
  • We develop contingency plans and facilitate communication among healthcare teams.
  • We discuss advanced directives when necessary and obtain acceptance from all parties involved.
  • We develop plans that advocate for patients and maximize benefit dollars.
  • We research and include costs of services and community resources in plan design.

Implementation and Monitoring

  • We implement plans based on assessments and skillfully negotiate and coordinate care.
  • We identify and coordinate resources to ensure plan success.
  • We work within plan networks and refer to high-quality providers when necessary.
  • We monitor the provision of coordinated plans and review care plans for compliance with standards of care.
  • We communicate outcomes of medical necessity reviews per policy.

Evaluation

  • We evaluate plans regularly to determine effectiveness, patient satisfaction, and provider comfort.
  • We determine if revisions are required due to changes in medical condition, family status, or insurance coverage.
  • We maintain availability and willingness to revise plans as needed.
  • We continue involvement as active, effective case managers.

We maintain well-organized, objective, factual, clear, and concise documentation that reflects our actions and decisions. We adhere to policies regarding timeliness and document the plan, including who, what, where, when, why, and costs. We also document patient and family teaching.

We perform as patient advocates in an ethical manner at all times, incorporating case management concepts and following industry standards and guidelines.

We become involved in the case management process as early as possible following the onset or diagnosis and maintain involvement throughout the course of the illness or injury. We manage cases along the entire spectrum of care, coordinating cost-effective plans that provide quality and continuity of care while eliminating duplication of services and wasted benefit dollars.

We demonstrate effective communication skills, both written and verbal, with all members of the treatment team, employer, and payer team.

We adhere to the Quality Assurance standards of the unit at a minimum of 85% of the time.

Qualifications

1. Active, unrestricted RN license in the state(s) of practice - Multi-State license required.

2. Current certified case manager (CCM) credential preferred.

3. A minimum of three (3) years of clinical experience in Behavioral Health Case Manager with experience in medical necessity review for admission for Intensive Outpatient, Inpatient admission, Substance Use Disorder treatment.

4. Ability to multi-task including navigation of multiple systems, multiple monitors, and having a conversation via telephone simultaneously.

5. Excellent time management and organizational skills, with the ability to maintain flexibility and work independently.

Equal Employment Opportunity Policy Statement

Lucent Health Solutions LLC is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.

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