Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making
- Ability to speak to medical and behavioral health professionals to influence appropriate member care.
- Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health
- In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals
- Identifies and escalates quality of care issues through established channels
- Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
- Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- 3 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
- Behavioral health or waiver experience preferred
- Foster care experience preferred
- Crisis intervention skills preferred
- Managed care/utilization review experience preferred
- Case management and discharge planning experience preferred
- Minimum of a Master’s degree in Behavioral/Mental Health or related field
- License in Social Work with Masters Required (e.g. LCSW, LMSW, LICSW,etc)
Vacancy Type: Full Time
Job Location: Charleston, WV, US
Application Deadline: N/A