Conducts comprehensive member psychosocial assessments through root cause analysis and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs. Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Assess members to recommend activities and behavioral routines to meet the social and medical needs of members and their families. Provides support and/or intervention and assists members in understanding the implications and complexities of their current medical situation and/or overall personal care.
Reports to: VP, Field Health Services
Department: Case Management
Location: Tampa, FL
Assesses, plans, implements, monitors and evaluates options and services to meet complex psychosocial health needs of inpatient and outpatient members. Manages a caseload in compliance with contractual obligations and WellCare standards.
Conducts comprehensive member assessments through root cause analysis based on referred member's needs and benefit plan eligibility, and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs.
Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Works towards achievement of optimal clinical and resource outcomes.
Monitors and evaluates effectiveness of care plan and modifies plan as needed. Supports member access to appropriate quality and cost effective care. Coordinates with internal and external resources to meet identified needs of the member's care plan and collaborates with providers.
Acts as a liaison and member advocate between the member/family, physician and facilities/agencies. Provides clinical consultation to physicians, professional staff and other teams members/supervisors to provide optimal quality patient care and effective operations.
Interacts continuously with members, family, physician(s), and other resources to determine appropriate behavioral action needed to address medical needs. Reviews benefits options, researches community resources, trains/creates behavioral routines and enables members to be active participants in their own healthcare.
Ensures members are engaging with their PCP to complete their care management treatment plan or preventive care services.
Assists in obtaining benefits for members through community resources when benefits are exhausted or not available.
Performs other duties as assigned.
In Hawaii, Registered Nurses may monitor the effect of medications, provide medication administration and education as needed under guidance of the Psychiatrist. The may provide education and clinical care for medical conditions and assists the Psychiatrist with member adherence to medications.
Incumbents engaged in Florida's SMI program will manage members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Incumbents will travel extensively to member's inpatient bedside, home or other facility.
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
2+ years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning
1+ year of experience in current case management as a licensed professional
Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Experience in a managed care environment
Ability to work independently
Ability to multi-task
Demonstrated time management and priority setting skills
Demonstrated interpersonal/verbal communication skills
Ability to create, review and interpret treatment plans
Ability to effectively present information and respond to questions from families, members, and providers
Knowledge of healthcare delivery
Knowledge of community, state and federal laws and resources
Demonstrated written communication skills
Demonstrated customer service skills
Ability to effectively present information and respond to questions from peers and management
Demonstrated problem solving skills
Licenses and Certifications: A license in one of the following is required:
Master's level independent or non-independent license is required OR an RN with a behavioral health background:
Registered Nurse (RN)
Licensed Clinical Social Worker (LCSW)
Licensed Clinical Mental Health Counselor (LCMHC)
Licensed Clinical Professional Counselor (LCPC)
Licensed Clinical Marriage & Family Therapist (LCMFT)