Health Plan Behavioral Care Manager (Onsite)
Adventist Health, Hillsboro, IL, United States
Job Summary
Assumes responsibility for utilization and case management of behavioral health cases. Collaborates with other staff in co-management of more complex cases. Contributes to the Population Health Plan Initiative.
Job Requirements
Education and Work Experience:
Associate's/Technical Degree or equivalent combination of education/related experience: Required
Bachelor's Degree: Preferred
Master's Degree in Social Work (LCSW): Preferred
Doctor's or Master's Degree (LMFT) from an accredited school: Preferred
Five years' clinical experience, including direct patient care: Preferred
Licenses/Certifications:
Licensed Clinical Social Worker or Licensed Psychologist: Required
Licensed Clinical Social Worker (LCSW) or Psychologist (PSYCH): Required
Facility Specific License/Certifications:
Licensed Clinical Social Worker (LCSW) in state of practice: Required
Essential Functions
Case manage or co-manage with the care management nurses for employees/dependents with behavioral health issues.
Develop care plans and work with the members and their providers toward effective outcomes.
Support the proper utilization of resources.
Perform concurrent and retrospective medical record/case review in accordance with the Care Management Program utilizing appropriate medical resources and clinical decision support tools.
Function as liaison to members, providers, case coordinators, discharge planners, contracted health plans/partners, and internal departments.
Counsel members in behaviors conducive to health.
Act as resource for our care management nurses and wellness coaches.
Develop focused programs, as needed (e.g., drug seeking members).
Assist with analytics review of claims data from varied sources relative to potential patient needs and program development.
Develop programs in support of our population health initiative.
Perform other job-related duties as assigned.
Organizational Requirements
Adventist Health is committed to the safety and wellbeing of our associates and patients. All associates must receive required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify.
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Assumes responsibility for utilization and case management of behavioral health cases. Collaborates with other staff in co-management of more complex cases. Contributes to the Population Health Plan Initiative.
Job Requirements
Education and Work Experience:
Associate's/Technical Degree or equivalent combination of education/related experience: Required
Bachelor's Degree: Preferred
Master's Degree in Social Work (LCSW): Preferred
Doctor's or Master's Degree (LMFT) from an accredited school: Preferred
Five years' clinical experience, including direct patient care: Preferred
Licenses/Certifications:
Licensed Clinical Social Worker or Licensed Psychologist: Required
Licensed Clinical Social Worker (LCSW) or Psychologist (PSYCH): Required
Facility Specific License/Certifications:
Licensed Clinical Social Worker (LCSW) in state of practice: Required
Essential Functions
Case manage or co-manage with the care management nurses for employees/dependents with behavioral health issues.
Develop care plans and work with the members and their providers toward effective outcomes.
Support the proper utilization of resources.
Perform concurrent and retrospective medical record/case review in accordance with the Care Management Program utilizing appropriate medical resources and clinical decision support tools.
Function as liaison to members, providers, case coordinators, discharge planners, contracted health plans/partners, and internal departments.
Counsel members in behaviors conducive to health.
Act as resource for our care management nurses and wellness coaches.
Develop focused programs, as needed (e.g., drug seeking members).
Assist with analytics review of claims data from varied sources relative to potential patient needs and program development.
Develop programs in support of our population health initiative.
Perform other job-related duties as assigned.
Organizational Requirements
Adventist Health is committed to the safety and wellbeing of our associates and patients. All associates must receive required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify.
#J-18808-Ljbffr