- Work telephonically with patients identified as high risk to identify needs, set goals and implement action steps towards achieving goals. Empower patients to help them improve their quality of life.
- Comply with established referral, pre-certification and authorization policies, procedures and processes by related Medical Management staff.
- Participate in on-going communication between case management staff, utilization management staff, health plan partners and contracted providers.
- Assist with the implementation of policies and procedures regarding case management and utilization management functions.
- Maintain compliance with federal and state regulations and contractual agreements.
- Coordinate case management functions with other departmental functions as assigned.
- Monitor the effectiveness of existing procedures and outreach/intervention efforts.
- Conduct appropriate knowledge/education and interventions for members defined to be at risk.
- Monitor data to address trends or potential quality improvement opportunities including provider issues, service gaps, member needs.
- Maintain HIPAA compliance.
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Behavioral Case Manager - Various, United States - LA Healthcare Connections
3 weeks ago
Description
You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team.
This is a hybrid role that consists of member home visits as well as remote work from home. Hours are M-F 8am to 5pm. Mileage reimbursement included. All Equipment supplied for role. Applicants must reside in or near Alexandria, Shreveport, or Monroe City.
Accepted licensures:
LPC, LCSW, LMFT
Position Purpose:
Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues.
Assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management Care Plan, monitor 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 Integrated Case Management functions.
Collaborate with both medical and behavioral providers to ensure optimal care for members.Education/Experience:
Master's degree in behavioral health and an unrestricted license as a LCSW, LMFT or LPC. 3+ years of case and/or utilization management experience. Experience in psychiatric and medical health care settings. Working knowledge of mental health community resources.
License/Certification:
Unrestricted license as a LCSW, LMHC, LMSW LMFT, LPC, PhD, PsyD or RN license in applicable state.
License/Certification:
Unrestricted license as a LCSW, LMHC, LMSW LMFT, LPC, PhD, PsyD, RN, ABA or BCBA license in applicable state.
ABA or BCBA highly preferred.Our Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.