Behavioral Health Case Management Specialist

Position Summary:

The BH Case Management Specialist will utilize skills to achieve client wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation. The BH Case Management Specialist will maintain a case load of patients referred from AHL BH providers and make and monitor appropriate referrals as requested by AHL providers; they will help identify appropriate internal/external providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner to obtain optimum value for both the client and the reimbursement sources. This position will work closely with the BH Transitional Care specialist regarding patients who had recently been hospitalized or utilized the ED and are moving into ongoing care at AHL. The BH Case Management Specialist will utilize an integrative care model between Primary Care and Behavioral Health by assessing, planning, facilitating and coordinating care to advocate for options and services to meet the comprehensive needs of patients /clients and families.

Minimum Qualifications
 
Education
·         Master’s degree from an accredited school of social work, psychology, substance use or related human services profession.

Experience
·         Three or more years of experience working in behavioral health.

Knowledge, Skills, and Abilities:

1. Understanding and proven experience in health management: prevention, screening, behavior modification, and mental health and substance misuse care modalities.

2. Demonstrated ability to work effectively with clients via phone.

3. Experience within a health care/managed care setting preferred

4. Proficient in MS office applications (MS Word, Outlook, Excel) required

5. Demonstrated ability to work in a fast-paced environment

6. Excellent communication skills, verbal and written, are required. Bilingual a plus.

7. Ability to work collaboratively and independently and effectively establish priorities

8. Ability to maintain integrity of confidential information

9. Effectively interact with individuals at all levels of the organization

10. Ability to support, encourage and inspire clients through coaching to manage their BH needs during transitional periods of care. Ability to listen to clients both spoken and unspoken and respond appropriately.

11. Able to deescalate and manage crisis effectively and calmly and knows when and how to engage emergency response.

12. Ability to use tact and diplomacy.

13. Ability to calmly manage patients who may present a high degree of frustration.

14. Knowledge of customer service principles and practices

15. Knowledge of HIPAA laws related to mental health and substance misuse treatment.

16. Knowledge of, and ability to communicate with, insurers about requirements/coverage, and to use this information to determine appropriateness of providing an appointment to a BH patient.

17. Knowledge of major mental illnesses and their associated, commonly prescribed medications and treatment continuums.

18. Knowledge of substance use disorders and commonly prescribed medications and treatment continuums.

19. Knowledge of, and ability to convey importance of, integrated care to promote primary care to BH patients.

Essential Duties/Responsibilities (Position):
1.       Client Relations

1. Achieves client satisfaction by greeting clients and proactively attending to their needs

2. Appropriately screens clients utilizing designated tools

3. Responds to client requests in timely and efficient manner

4. Maintains confidentiality on and off duty

5. Maintains contacts with payers and patients for processing of follow-up care

6. Provides substance abuse education to students, families and / or community health care practitioners and groups, within area of specialty.

2.       Assessment

1. Performs initial consultations, follow up and education relevant to the client’s care (age specific)

2. Obtains histories and develop notes, ensuring accuracy and competency

3. Acts as an advocate for the safety delivery of care and well-being of the client

4. Documents client care, changes in treatment or symptoms and interventions and strategies in response to changes

5. Consults with colleagues when there is information that will assist with service delivery.

6. Empowers clients and families about diagnosis.
   

3. Implementation

1. Assists in obtaining referrals, prior authorizations and other information necessary for services

2. Maintains knowledge of referral lists for additional supportive services

3. Provides on-going supportive and/or case management functions in accordance with the problems, needs, and the strategies identified within the service plan in order to help the clients to achieve the stated goals and objectives.

4. Provides face to face reviews with the client and/or relevant staff on a regular basis the progress made in reaching service goals so that the service plan can be modified as necessary to ensure that the goals and objectives are being achieved. The frequency reviews will be determined by relevant requirements.

4.       Evaluation

1. Critical thinking ability sufficient for identifying cause and effect relations in clinical situations.

2. Evaluates client status and response to treatment

3. Modifies plan of care based on evaluation of client outcomes

4. Evaluates continued need for care or need for referral to other providers or support

5. Develops appropriate treatment/service plans with clients as the means for implementing appropriate services and developing effective alliances with clients.

5. Safety/Infection

1. Follows job safety requirements.

2. Reports accidents or incidents within 8 hours of occurrence by completing an incident report and forwarding to immediate supervisor and appropriate personnel.

Physical and Mental Requirements

1. Communicate with internal staff, patients and outside entities.

2. Stands, sits, walks, and converses most of the day.

3. Ability to lift, carry, push, pull or move objects less than 10 pounds occasionally

4. OSHA Category III: Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

5. Operates telephone, computer terminal, printer, fax copier, while performing certain duties.

II: ORGANIZATION-WIDE

Customer Relations

1. Treats guests, patients, physicians, and other employees with care, courtesy and respect.

2. Responds quickly and appropriately to customer requests.

3. Looks for and suggests ways to better meet customer needs.

4. Answers the clinic communications system promptly and with courtesy and respect.

Teamwork

1. Works cooperatively within own department and other areas.

2. Willingly accepts additional responsibilities – tries to make others’ job easier.

3. Responds quickly to request for assistance.

4. Required to work closely with patients and associates.

5. Interacts with other departments on problem issues. Accepts feedback from patients, visitors, clinic employees, physicians and general public.

Continuous Improvements:

1. Continuously look for and suggests ways to improve.

2. Effectively completes assignments to achieve the greatest benefit at acceptable cost.

3. Implements improvements as appropriate.

4. Demonstrates interest in own growth and development by:

1. Periodically evaluating own performance.

2. Demonstrating an awareness of personal abilities and limitations.

3. Independently seeking means to make improvements.

4. Attending and participating in in-service and continuing education process.

5. Attend departmental meetings and clinic wide meetings.

Communications:

1. Keeps appropriate people informed.

2. Speaks and writes clearly, concisely and appropriately for need.

3. Listens carefully.

4. Communicates tactfully.

5. Understands that all confidentially and privacy considerations are respected and fostered at work and off duty.

Self-Management

1. Presents a positive image of Access Health Louisiana

2. Carries out assignments with little need for direction.

3. Timeliness.

4. Maintains confidentiality.

5. Provides proper notification of absence and tardiness.

6. Works weekends and shifts when necessary.

This job description includes the major duties and responsibilities of the job but is not inclusive of every task inherent to the job. In addition, it may be occasionally necessary for employees to be assigned tasks not specifically covered by their permanent assignment. Employees will be expected to comply with reasonable requests from their supervisor.