WellSense Health Plan
Overview
Join to apply for the
BH Care Manager
role at
WellSense Health Plan . The Behavioral Health (BH) Care Manager provides care management services to WellSense members with behavioral health and substance use needs. This role functions as part of an interdisciplinary team and collaborates closely with Utilization Management and Care Management staff, Pharmacy, and leadership. The BH Care Manager supports members across the healthcare continuum, serving as liaison between WellSense and hospital staff, primary care providers (PCPs), and other healthcare professionals. Responsibilities include the management of complex and non-complex cases, coordinating transition of care, discharge planning support, conducting assessments and developing plans of care, and care management interventions. Job location: Remote work available. WellSense is a nonprofit health plan serving members across Massachusetts and New Hampshire. Key Functions / Responsibilities
Deliver comprehensive, client-centered behavioral health and substance use care management and disease management services Conduct assessments, screenings, and interventions telephonically as well as in the community or at facilities when required and approved by the supervisor or manager Develop, implement, and monitor individualized care plans (ICPs) addressing members’ needs and barriers, including member preferences and input from the care team Facilitate transition of care from inpatient facilities to post-acute settings or community by coordinating with facilities, 24-hours diversionary services, outpatient services, utilization management, care management teams, and other professionals Use behavioral health techniques such as Motivational Interviewing, Active Listening, Harm Reduction, Strength-Based approach, Trauma-informed care, and CBT Coordinate care to ensure timely service delivery across the healthcare continuum, identify gaps, secure follow-up appointments, and engage with providers and community organizations Provide educational materials and psychoeducation to members and families about mental health and substance use disorders and their treatment Outreach to members for medication monitoring and to encourage adherence; educate about medications in recovery as needed Collaborate with members, families, caregivers, care team members, providers, and state agencies in treatment planning and care coordination Serve as liaison between hospitals, PCPs, BH providers, external agencies, and the care team Conduct and document assessments, interventions, and coordination of care activities per WellSense policies and regulatory standards Support initiatives to reduce hospital readmissions and improve health outcomes and quality of life Participate in quality assurance and quality improvement activities and audits Provide crisis intervention using clinical judgment to de-escalate situations Attend round meetings presenting cases or recommendations to other care managers Meet departmental productivity and quality standards; maintain caseload and turnaround times After-hours availability as needed; regular and reliable attendance required Performs other duties as assigned Supervision
No direct supervision exercised General supervision is received weekly Qualifications
Education: A master’s or doctoral degree in a behavioral health field such as psychology, clinical counseling, or social work Experience: Two or more years of related experience in Mental Health, BH Case Management, and/or substance abuse treatment Experience Preferred / Desirable: Medicaid experience; care management or care coordination; health plan or insurance environment; services to children, adolescents, adults, and/or geriatric populations; experience with SUD or co-occurring disorders; bilingual/multilingual Certification or Conditions of Employment: Current certificate or state licensure (Massachusetts: LICSW, LMHC, LMFT, or LADC preferred with additional licensure; New Hampshire: LICSW, LCMHC, LMFT, or MLADC with licensure); CCM preferred Skills & Attributes
Ability to work in a fast-paced environment and multi-task Proficiency with Microsoft Office and data entry applications Strong analytical and clinical problem-solving skills Ability to plan, organize, implement and manage projects within a healthcare setting Detail-oriented with strong analytical capabilities Ability to work independently and as part of a team Strong oral and written communication skills and ability to interact across all levels of the organization Working Conditions
Travel to member locations as required Remote work is typical but may require travel to community sites and occasional meetings at the corporate office About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. WellSense is committed to diversity and inclusion. EEO statement and background checks apply as required by law.
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Join to apply for the
BH Care Manager
role at
WellSense Health Plan . The Behavioral Health (BH) Care Manager provides care management services to WellSense members with behavioral health and substance use needs. This role functions as part of an interdisciplinary team and collaborates closely with Utilization Management and Care Management staff, Pharmacy, and leadership. The BH Care Manager supports members across the healthcare continuum, serving as liaison between WellSense and hospital staff, primary care providers (PCPs), and other healthcare professionals. Responsibilities include the management of complex and non-complex cases, coordinating transition of care, discharge planning support, conducting assessments and developing plans of care, and care management interventions. Job location: Remote work available. WellSense is a nonprofit health plan serving members across Massachusetts and New Hampshire. Key Functions / Responsibilities
Deliver comprehensive, client-centered behavioral health and substance use care management and disease management services Conduct assessments, screenings, and interventions telephonically as well as in the community or at facilities when required and approved by the supervisor or manager Develop, implement, and monitor individualized care plans (ICPs) addressing members’ needs and barriers, including member preferences and input from the care team Facilitate transition of care from inpatient facilities to post-acute settings or community by coordinating with facilities, 24-hours diversionary services, outpatient services, utilization management, care management teams, and other professionals Use behavioral health techniques such as Motivational Interviewing, Active Listening, Harm Reduction, Strength-Based approach, Trauma-informed care, and CBT Coordinate care to ensure timely service delivery across the healthcare continuum, identify gaps, secure follow-up appointments, and engage with providers and community organizations Provide educational materials and psychoeducation to members and families about mental health and substance use disorders and their treatment Outreach to members for medication monitoring and to encourage adherence; educate about medications in recovery as needed Collaborate with members, families, caregivers, care team members, providers, and state agencies in treatment planning and care coordination Serve as liaison between hospitals, PCPs, BH providers, external agencies, and the care team Conduct and document assessments, interventions, and coordination of care activities per WellSense policies and regulatory standards Support initiatives to reduce hospital readmissions and improve health outcomes and quality of life Participate in quality assurance and quality improvement activities and audits Provide crisis intervention using clinical judgment to de-escalate situations Attend round meetings presenting cases or recommendations to other care managers Meet departmental productivity and quality standards; maintain caseload and turnaround times After-hours availability as needed; regular and reliable attendance required Performs other duties as assigned Supervision
No direct supervision exercised General supervision is received weekly Qualifications
Education: A master’s or doctoral degree in a behavioral health field such as psychology, clinical counseling, or social work Experience: Two or more years of related experience in Mental Health, BH Case Management, and/or substance abuse treatment Experience Preferred / Desirable: Medicaid experience; care management or care coordination; health plan or insurance environment; services to children, adolescents, adults, and/or geriatric populations; experience with SUD or co-occurring disorders; bilingual/multilingual Certification or Conditions of Employment: Current certificate or state licensure (Massachusetts: LICSW, LMHC, LMFT, or LADC preferred with additional licensure; New Hampshire: LICSW, LCMHC, LMFT, or MLADC with licensure); CCM preferred Skills & Attributes
Ability to work in a fast-paced environment and multi-task Proficiency with Microsoft Office and data entry applications Strong analytical and clinical problem-solving skills Ability to plan, organize, implement and manage projects within a healthcare setting Detail-oriented with strong analytical capabilities Ability to work independently and as part of a team Strong oral and written communication skills and ability to interact across all levels of the organization Working Conditions
Travel to member locations as required Remote work is typical but may require travel to community sites and occasional meetings at the corporate office About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. WellSense is committed to diversity and inclusion. EEO statement and background checks apply as required by law.
#J-18808-Ljbffr