Job Profile Summary:
Position Purpose:
Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder.
Education/Experience:
Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2 4 years of related experience.
License/Certification:
Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required
For Illinois Youth Care plan only: Graduate degree and independently licensed behavioral health clinician (e.g. LCSW, LCPC, PsyD) in Illinois or Bachelor s Degree and IL RN licensure. Must reside in IL required
For NJ Health Plan Only: Requires a Master's degree in Behavioral Health or Social Work and a Licensed Associate Counselor (LAC) or Licensed Social Worker (LSW) required
For Sunshine Health (FL) Only: Employees supporting Florida's Children s Medical Services must Hold a Master s degree in social work or related field and have one year of related professional pediatric care experience. May require up to 80% local travel required
Responsibilities:
Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs
May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources
Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders
Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members
Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs
Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services
Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs
Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
Performs other duties as assigned.
Complies with all policies and standards.
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
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| Story Behind the Need |
- What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
| Behavioral Health Care Management Team. Outreach to members identified for BH CM. Work with members telephonically to remove barriers of care. This is a high functioning and very productive team that works collaboratively. Very supportive to each other. |
| Typical Day in the Role |
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
| Call members and engage in CM. Make 15-20 calls per day. Complete assessments and care plans. Work with facilities and providers to arrange outpatient services. Crisis calls |
| Candidate Requirements Case Management, discharge planning, community mental health a plus |
| Education/Certification | Required: Masters | Preferred: |
| Licensure | Required: LCSW LMSW LPC | Preferred: |
Years of experience required: 2+ years in BH an care management, community mental health, hospital
Disqualifiers:
Additional qualities to look for: |
- Top 3 must-have hard skills stack-ranked by importance
| 1 | Efficient |
| 2 | Strong communication and documentation skills. |
| 3 | Tech savvy |
| Candidate Review & Selection |
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
| Projected Manager Candidate Review Date: | 1-2 days post shortlisting |