Your Role
The Behavioral Health Care Management Clinician, Senior helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and programs. The Behavioral Health Care Manager will offer support in assessing members’ emotional and psychological well-being and providing resource coordination, crisis intervention, substance abuse, and with any behavioral or mental health referrals. The Behavioral Health Care Manager will be available to physicians and nurse care managers as a consultant for patients with complex psychosocial needs. The position requires an intensive focus on crisis intervention and counseling, problem-solving and conflict resolution, patient and family management, interdisciplinary collaboration, psychosocial assessments, education, advocacy, and community resource linkages.
Responsibilities
Your Work
- Collaborate with case managers and other team members to complete member assessments related to social and resource needs to support member access to services
- Collaborate with service coordination staff and act as liaison to ensure a timely and accurate response to member needs
- Collaborate with providers to support members’ treatment plan and care needs
- Recognize the client’s right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team
- Assess members health behaviors, cultural influences and clients belief/value system and evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers
- Efficiently manages and maintains a caseload of members for behavioral health care coordination and or BH case management for persons experiencing severe and persistent mental illness.
- Maintains an active workload in accordance with National Care Manager performance standards.
- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
- Interacts with Utilization department and Physician Advisors to discuss clinical questions and concerns regarding specific cases.
- Coordinates services with state and community programs on behalf of the member, particularly when the member is unable to effectively do so independently
- As a mandated reporter, files and follows-up on reports made to the appropriate government agency (e.g., Adult Protective Services, Child Protective Services, etc.)
- Actively participates in Interdisciplinary Team Meetings and case consultations with Licensed Manager.)
Qualifications
Your Knowledge and Experience
- Requires a current and valid CA RN License or valid RN license(s) from other state(s). Preferred licensure from a compact state. If assigned to another state, you must maintain an active, unrestricted RN license in assigned state(s) or the ability to obtain required RN license (in addition to primary state license) within 90 days of hire
- Bachelor of Science in Nursing or advanced degree preferred
- Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
- Requires 5 years of experience in nursing, healthcare, or related field
- A minimum of 3 years of managed care experience in inpatient, outpatient, or managed care environment preferred
- Transitions of care experience preferred
- Strong knowledge of healthcare delivery systems, managed care principles, and care coordination
- Excellent communication skills
- Experience conducting thorough psychosocial assessments, developing care plans and providing necessary interventions identified during assessment with complex client populations that may have, among other things, inadequate coping skills, severe emotional disorders, developmental disabilities, mental illnesses, and/or unstable housing
- Considerable knowledge of a wide range of psychosocial challenges and familiarity with behavioral health diagnoses and treatment
- Proficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come into the office based on business need.
MUST BE ABLE TO WORK M-F 8am-5pm PST