Job Summary:
Assumes responsibility for utilization and case management of behavioral health cases. Collaborates with other staff in co-management of more complex cases. Contributes to the Population Health Plan Initiative.
Job Requirements:
Education and Work Experience:
- Associate's/Technical Degree or equivalent combination of education/related experience: Required
- Bachelor's Degree: Preferred
- Master's Degree in social work (LCSW): Preferred
- Doctor's or Master's Degree (LMFT) from an accredited school: Preferred
- Five years' clinical experience, including direct patient care: Preferred
Licenses/Certifications:
- Licensed Clinical Social Worker or Licensed Psychologist: Required
- Licensed Clinical Social Worker (LCSW) or Psychologist (PSYCH): Required
Facility Specific License/Certifications:
- Licensed Clinical Social Worker (LCSW) in state of practice: Required
Essential Functions:
- Case manage or co-manage with the care management nurses for employees/dependents with behavioral health issues.
- Develops care plans and works with the members and their providers toward effective outcomes. Supports the proper utilization of resources.
- Performs concurrent and retrospective medical record/case review in accordance with the Care Management Program utilizing appropriate medical resources and clinical decision support tools.
- Functions as liaison to members, providers, case coordinators, discharge planners, contracted health plans/partners and internal departments. Counsels members in behaviors conducive to health. Acts as resource for our care management nurses and wellness coaches. Develops focused programs, as needed (i.e. drug seeking members).
- Assists with analytics review of claims data from varied sources relative to potential patient needs and program development. Develops programs in support of our population health initiative.
- Performs other job-related duties as assigned.
