We are currently seeking a dynamic CASE MANAGER to join our team at our office in Kapolei. Beacon Health Options is the behavioral partner for HMSA. Case management services is for eligible HMSA members. The case manager facilitates a collaborative relationships among members, providers, community agencies and HMSA staff in order to ensure members receive timely and integrated access to services across the continuum of care, including supporting and managing member's physical, emotional, social and economic barriers to appropriate behavioral health care. The Case Manager is responsible for triaging, assessing, and managing of members referred to Case Management. Responsible for the tracking and managing of members identified as needing Case Management who may be high risk, high utilizing, at significant clinical risk or under-utilizing services. The Case Manager is responsible for providing outreach, case management, education and support to HMSA members by performing clinically based activities to coordinate care between the members, providers and community resources.
• Outreaching and tracking of all assigned HMSA members identified as having a behavioral health need
• Conducts independent assessment and re-assessment of members enrolled in CM in compliance with program standards
• Development of a comprehensive care plan to address areas or risk and/or need as identified via the assessment; updates the care plan as clinically indicated
• Maintains on-going contact with the member/ guardian
• Provides continuum of quality care through field and telephonic outreach, education, crisis intervention and other clinically based activities to plan members as specified in their treatment plans.
• Collaborates and coordinates with member's medical/health and community based providers (including the PCP, medical professionals, behavioral health specialists, or others as needed) regarding the member's treatment/discharge needs and plan of care.
• Collects clinical data and maintains accurate records of activities information into database for tracking and metrics purposes.
• Participate in collaborative discussions with the Beacon clinical team to review high risk members to ensure member needs are being met.
• Assist with NCQA and URAC initiatives, including but not limited to ensuring compliance with NCQA MBHO QI9
• Provide Service Coordination to HMSA QUEST members with a behavioral health special health care need as needed.
Education: Staff providing Case Management services will have at least one of the following:
Licensure: Must have current, valid and unrestricted Hawaii licensure with proof upon date of hire. Re-verification will take place no less than every 3 years.
Knowledge, Skills & Abilities:
3 plus years of Case Management experience
Educated in current principles, procedures and knowledge domains of case management based on nationally recognized standards of case management
Ability to prioritize and manage multiple projects and assignments.
Knowledge of client's rights, state and federal laws, and regulations, such as those relating to health services, confidentiality, and consent issues for the targeted population.
Knowledge of HIPAA and other privacy regulations
Ability to work independently, handle multiple assignments and prioritize workload.
Ability to seek help in managing workload, when appropriate.
Position requires ability to work in an office environment, but allows the flexibility to work from home ocassionally.
Requires safely operating an insured automobile for travel to off-site locations to conduct and accomplish business related activities. Must have current and valid driver’s license, access to an automobile with current registration and no fault insurance.
Able to travel to off-site meetings with members, providers and community agencies. Must be able to transport self and equipment to community sites, member homes, physician offices etc. May require ability to travel to Neighbor Islands and flexibility in being available to work after hours and on weekends when needed.