The Health Plan of West Virginia, Inc.
Behavioral Health Case Manager
The Health Plan of West Virginia, Inc., Wheeling, West Virginia, United States, 26003
Behavioral Health Case Manager will assess members for behavioral health or substance use needs and provide services to ensure members are receiving cost-effective, quality-based health care by developing a plan of care that addresses individual needs for the member based on their assessment, needs, and benefit plan. The primary responsibility of the BH CM is to assist in navigating the healthcare system, provide education and support while working with members and providers to set goals associated with their plan of care. The BH CM will monitor, evaluate and revise care plans and communicate regularly with the providers and member. The BH CM will collaborate other THP care managers to ensure medical needs are addressed and all goals are met.
Required:
Minimum of associate's degree in nursing or relevant field (nursing or social work). Minimum of three years' experience in behavioral health direct care arenas. Active Ohio or WV license as a registered nurse or social worker. Familiarity with community resources for health and for social determinants of health. Familiarity/experience with Microsoft Office Programs (Word, Excel, Outlook).Excellent. Excellent verbal, written, telephonic and interpersonal communication skills. Desired:
Familiarity with the interdisciplinary team process. Case management experience. Responsibilities:
Coordinate and provide BH case management services that are safe, timely, effective, efficient, equitable, and client centered. Handle case assignments, perform comprehensive and thorough behavioral, functional and social determinant of health assessments, develop and maintain care plans, review case progress and determine case closure. Help members achieve wellness and autonomy. Facilitate multiple care aspects (care coordination, condition education, utilization management, information sharing, redirection/transitional care, cost containment, benefit maximization, etc.) across the care continuum inclusive of communications with all relevant multi-disciplinary care team members. Help members make informed decisions by acting as a resource and advocate regarding their clinical status and treatment options. Develop effective working relations within the industry and cooperate with medical/behavioral team members throughout the entire care coordination process. Arrange non-benefit services with community-based agencies, external social services, health and governmental agencies. Thoroughly develop and document interactions with patients and families to keep track of their progress towards goals and to ensure satisfaction. Record case information, complete accurately and timely all necessary referrals, reviews, assessments, care plans, notes, activities, forms and workflows to produce results evidencing adherence to case management interrater review benchmarks and NCQA, CMS and/or BMS regulatory standards as appropriate. Promote quality and cost-effective interventions and outcomes in accordance with plan benefits. Assess and address motivational and psychosocial issues. Adhere to professional standards as outlined by protocols, rules and regulations.
Equal Opportunity Employer
The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
8:00am-5:00pm 40
Required:
Minimum of associate's degree in nursing or relevant field (nursing or social work). Minimum of three years' experience in behavioral health direct care arenas. Active Ohio or WV license as a registered nurse or social worker. Familiarity with community resources for health and for social determinants of health. Familiarity/experience with Microsoft Office Programs (Word, Excel, Outlook).Excellent. Excellent verbal, written, telephonic and interpersonal communication skills. Desired:
Familiarity with the interdisciplinary team process. Case management experience. Responsibilities:
Coordinate and provide BH case management services that are safe, timely, effective, efficient, equitable, and client centered. Handle case assignments, perform comprehensive and thorough behavioral, functional and social determinant of health assessments, develop and maintain care plans, review case progress and determine case closure. Help members achieve wellness and autonomy. Facilitate multiple care aspects (care coordination, condition education, utilization management, information sharing, redirection/transitional care, cost containment, benefit maximization, etc.) across the care continuum inclusive of communications with all relevant multi-disciplinary care team members. Help members make informed decisions by acting as a resource and advocate regarding their clinical status and treatment options. Develop effective working relations within the industry and cooperate with medical/behavioral team members throughout the entire care coordination process. Arrange non-benefit services with community-based agencies, external social services, health and governmental agencies. Thoroughly develop and document interactions with patients and families to keep track of their progress towards goals and to ensure satisfaction. Record case information, complete accurately and timely all necessary referrals, reviews, assessments, care plans, notes, activities, forms and workflows to produce results evidencing adherence to case management interrater review benchmarks and NCQA, CMS and/or BMS regulatory standards as appropriate. Promote quality and cost-effective interventions and outcomes in accordance with plan benefits. Assess and address motivational and psychosocial issues. Adhere to professional standards as outlined by protocols, rules and regulations.
Equal Opportunity Employer
The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
8:00am-5:00pm 40