Perform duties related to the day-to-day operations of the Behavioral Health Team. Case Management works with high risk Members to help identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assessed Members current functional level and, in collaboration with the Member, develops and monitors the Case Management Care Plan, quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the Behavioral Health Case Management functions. Collaborate with both medical and behavioral providers, often onsite at hospitals or in the community, to ensure optimal care for Members. Work telephonically with patients and their Legal Authorized Representative identified as high risk, for both behavioral and physical health issues, and their providers to identify needs, set goals and implement action steps towards achieving goals. Understand and comply with NCQA/ URAC guidelines and HEDIS measures.
1. Education/Specialized Training/Licensure: Master's Degree in Social Work or Counseling
Current unrestricted license in the state of Texas: LCSW, LMSW, LMFT or LPC
2. Work Experience (Years and Area): 2 years experience in managed care or hospital setting and 2 years in behavioral health case management preferred
3. Management Experience (Years and Area): N/A
4. Equipment Operated: Advanced PC knowledge, MS Word, MS Excel, MS Outlook, and excellent telephone skills.
SPECIAL REQUIREMENTS: (Check Applicable Areas)
1. Communication Skills:
Above Average Verbal (Heavy Public Contact)
Exceptional Verbal (e.g., Public Speaking)
Writing /Composing Yes (Correspondence / Reports)
2. Other Skills:
3. Advanced Education:
Advanced Training Specialty: LMSW, LCSW, LPC
Master's Degree Major: Social Work or Counseling
4. Work Schedule
5. Other Requirements:
Excellent organization, coordination, and multi-tasking skills and abilities. Ability to organize and prioritize tasks and work independently. Strong attention to detail and deadlines. Will travel locally to hospitals as requested by manager or medical director when high risk or high utilizing member is inpatient.