$5,000 Sign On Bonus for External CandidatesThe Behavioral Health Case Manager will be responsible for the management and coordination of Case Management services for members with complex needs and requiring complex service. The Outpatient Case Manager works directly with the member, provider(s), facilities, and other entities to ensure the most appropriate care is provided. The Case Manager manages members from all contracted product lines. The Case Manager assesses, plans, implements, coordinates, monitors, and evaluates the outcomes, ensuring options and services required to meet the member's health needs are best utilized. The Case Manager provides education, advocacy, communication, and resource management and promotes quality, self-management, and cost-effective interventions and outcomes.
Candidate must be available to work Monday - Friday 8:00 am - 5:00 pm and to travel up 25% of the time throughout the Clark or Washoe County, NV area. If you reside within a commutable distance from the Las Vegas, NV area, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:- Perform Member assessment of all major domains using evidence-based criteria (behavioral, physical, functional, financial and psychosocial)
- Assess, plan and implement care plan strategies that are individualized by Member and directed toward the most appropriate, least restrictive level of care, to achieve recovery and adaptive functioning and monitor progress toward their goals
- Utilize both company and community-based resources to establish a safe and effective case management plan for Members
- Collaborate with Member, family, and health care providers (PCP, BH Providers) to develop an individualized plan of care and supportive services for members
- Support and coordinate Member behavioral health services and integrated substance use disorder treatment, supporting medication management, symptoms management, rehabilitation, crisis stabilization, and psychosocial education on an outpatient basis
- Provide advocacy, health education, coaching, referrals and treatment decision support for Members and their caregivers
- Meet with Members via telephone or in the community (in their home, at their providers' office, community settings or at inpatient facilities) if requested, deemed appropriate, or warranted
- Document activities according to established standards and ensure files meet NCQA/Medicaid requirements
- Accountable to understand role and how it affects utilization management benchmarks and quality outcomes
- Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan
- Takes in-bound calls and places out-bound calls as dictated by Member and business needs
- Special projects, initiatives, and other job duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- Current, unrestricted LCSW, RN, LMFT or CPC license in State of Nevada
- 2+ years of behavioral health experience
- Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word
Preferred Qualifications:- CCM certification or ability to obtain within 2+ years of employment
- 2+ years of case management/utilization review experience
- Knowledge of patient care delivery in a managed care environment
- Basic knowledge of both state programs and the community-based services
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
