Oversees the day-to-day operations of behavioral case management as it relates to the psychosocial, socioeconomic needs and services of select member populations across the continuum of care. Ensures team is compliant with all Model of Care regulatory requirements and produces optimal clinical, socioeconomic, psychosocial and resource outcomes. Ensures the inpatient and outpatient case management process of assessing, planning, implementation, monitoring, and evaluating services and outcomes is pursued to maximize the health of the member with high acuity psychosocial needs and/or behavioral health conditions.
Reports to: Dir. of Field Care Management
Department: Health Services
Location: West Palm Beach, FL, Miami Gardens, FL, Jacksonville, FL, Ft. Myers, FL, Tallahassee, FL, Ocala, FL
Works directly with staff and members to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member. Implements utilization and/or case management workflows and policies and procedures for integrated behavioral health programs.
Proactively monitors appropriate metrics to drive efficiency.
Provides leadership and support to front-line staff and supervisors of behavioral health services in the assigned market(s) or state.
Provides recommendations and support to behavioral health leadership for future expansion and growth efforts.
Serves as an instrumental partner in monitoring and tracking key performance indicators to include identification of over/under utilization and/or case management patterns and/or deviation from expected results for assigned market(s) or state.
Assists with development of clinically-focused training associated with behavioral health assessment, care plan development and behavioral health services in the market(s) or state.
Performs audits of assessments, case plans and service notes to verify cases are properly established and that member coordination activates are occurring and appropriately documented.
Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history, mental health history and current status. Assesses the options for care including use of benefits and community resources to update the care plan and coordinate services.
Act as a liaison and member advocate between the member/family, physician and facilities/agencies.
Provides training and guidance to new and current behavioral health associates regarding policy and procedure, systemic tools, workload and care plan development.
Ensures regulatory requirements and accreditation standards are applied to all activity and reporting.
Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.
Function as subject matter expert for behavioral health processes, mental health services and psychosocial programs.
Performs other duties as assigned
Required A Master's Degree in Social Work, Psychology, Counseling, Rehabilitation, or other relevant field that provides a foundation to receive a license as required of the position
Required 5+ years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning
Required 1+ year experience in leading/supervising others
Required 3+ years of experience in a managed care environment (as a licensed mental health professional )
Required Other Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Intermediate Ability to communicate and make recommendations to upper management
Intermediate Ability to effectively present information and respond to questions from families, members, and providers
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
Intermediate Demonstrated time management and priority setting skills
Intermediate Ability to multi-task
Intermediate Ability to lead/manage others
Advanced Ability to create, review and interpret treatment plans
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Demonstrated problem solving skills
Intermediate Knowledge of community, state and federal laws and resources
Intermediate Demonstrated written communication skills
Intermediate Demonstrated customer service skills
Advanced Knowledge of healthcare delivery
Licenses and Certifications: A license in one of the following is required:
Other One of the following is required:
Required Licensed Clinical Social Worker (LCSW)
Required Licensed Clinical Mental Health Counselor (LCMHC)
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel
Required Intermediate Healthcare Management Systems (Generic)