Pay Range:

Please email  if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

Why this job matters:

Behavioral Health Care Manager will direct and coordinate the beneficiary’s care. Complete the Health Risk Assessment with the D-SNP member and/or the comprehensive assessment, coordinate care across the health care continuum, coordinating benefits, managing the members of the ICT, and developing and maintaining the ICP. Responsible for taking the problems/barriers from the Health Risk Assessment and incorporating into the Interdisciplinary Care Plans. Educate the beneficiary and/or caregiver on self-management strategies and skills. Collaborate with other team members, providers, community agencies and caregivers/ natural supports to facilitate the development of the ICP. Work closely with the health navigator to support self-management activities and the associated SMART goals. Facilitate communication among the beneficiary, providers, health plan, and others who participate in the beneficiary’s care. Provide consultation and support to the other team members, such as the RN Care Manager, Social Worker, Dietitian, Pharmacist, and the Health Navigator to support integrated care management delivery.

What you will do:

• Manage members through the behavioral healthcare delivery system; assess needs in order to identify appropriate interventions
• Conduct telephonic or face to face health assessments to identify high risk or emerging risk members who would benefit from education and intervention
• Facilitate communication between members, providers, and stakeholders to coordinate and implement action plans aimed at improving the members’ total health
• Identify opportunities to impact claims expense trends for all lines of business/or at the individual member level
• Evaluate action plans by working with members and collaborating with providers.  Modify action plans as necessary.
• Monitor and evaluate patient services to ensure appropriate coordination of care
• Collaborate with the Utilization Review process including pre-authorization, concurrent review, screening cases for quality-of-care issues, and discharge planning
• Promote member and provider satisfaction by demonstrating working knowledge of member benefits, including but not limited to health, disability, Employee Assistance or other plans/benefits available to the member
• Provide continuity and consistency of care by building positive relationships between the member and family, physicians, provider, care coordinator, and health care plan
• Work collaboratively with the team and others necessary to develop and implement solutions. Identify barriers to performing job duties as well as opportunities for improvements. Exemplifying the corporate values in action through accountability, collaboration, integrity and respect in maintaining a high-performance culture.
• Utilize medical record programs and maintaining proper documentation for a vast caseload
• Participate in department initiatives and projects
• Perform other duties as assigned
• Conduct community based visits, such as in homes, provider offices, hospitals, and treatment centers, as required.
• Medicare and Medicaid, including LTSS (long term services and supports) experience preferred

What you need to succeed:

• Rhode Island licensed independent clinical social worker (LICSW) or licensed mental health counselor (LMHC)
• Three to five years’ experience in a medical/clinical environment or managed health plan
• Must obtain Certified Case Manager (CCM) certification within three years of employment*
• Knowledge of utilization management and/or coordination of care
• Knowledge of population health and chronic condition management principles
• Understanding of health care delivery system access points and services
• Ability to navigate the healthcare delivery system
• Good business acumen
• Knowledge of business process improvement techniques and strategies
• Excellent verbal, written communications and technical skills
• Negotiation skills
• Presentation skills
• Decision-making skills
• Good problem-solving skills
• Ability to interface with employees at all levels
• Ability to effectively navigate ambiguous situations with limited direction
• Excellent organizational skills and ability to successfully prioritize multiple tasks
• Ability to handle multiple priorities/projects
• Strong time management skills

*Applies to positions working with FEP product only

The extras:

• Experience working in a managed care/health maintenance organization
• Knowledge of healthcare plans and benefits
• Bi Lingual candidates preferred

Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia