Job Description

Location: US Family Health Plan
Posted Date: 7/20/2021

Under the direction of the Director QCM, the Behavioral Health Care Manager coordinates with the USFHP third party administrator (TPA) management of patient care for the defined populations, including members with behavioral health conditions. This position will act as the central point of contact for the TPA in care coordination, supporting them through transitions of care. Receives care management reports targeting high risk patients to ensure quality care and patient safety. Coordinates care for members in the ECHO program and the Autism Demonstration Project.

KEY RESPONSIBILITIES:

  • In collaboration with the member’s TPA case manager, the BHCM works with high risk members and those with behavioral health issues to coordinate services. The BHCM navigates the member through the health care system with a goal of enabling them and their family to effectively manage their condition(s) and optimize outcomes. Will educate Plan members on benefits and community resources, as needed.
  • As needed, coordinates with the TPA effective transitions of care and effective handoffs to the next level of care across the entire continuum.
  • Utilizes available reports to proactively prioritize the needs of the high-risk members and those with behavioral health issues, including the ECHO program and Autism Demonstration Project, and coordinates interventions.
  • Actively reviews available reports, considers care management (CM) impact; recommends and makes modifications to the plan of care, as needed.
  • Evaluates processes, identifies problems, and proposes improvement strategies to enhance the delivery of care for patients throughout continuum of care. Maintains awareness of key performance indicators/metrics. Coordinates interventions to prevent adverse events such as ED visits, hospital admissions and readmission.
  • Performs other duties as assigned.

REQUIRED KNOWLEDGE & SKILLS:

  • Must exhibit strong critical thinking, problem-solving, interpersonal and good patient interviewing skills.
  • Highly motivated and self-directed.
  • Ability to interpret clinical information, assess the implication of treatment and develop and implement a plan of care.
  • Demonstrated ability to prioritize, multitask, and work in a rapidly changing environment with multiple demands.
  • Ability to work effectively in a team.
  • Attend staff meetings and education offerings both in person and via teleconference as required.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

  1. Education: Graduate of a state-approved school of social work or nursing, LICSW or BSN preferred. Possess a current unrestricted RN or LICSW licensure in the Commonwealth of Massachusetts.
  2. Experience: (Type & Length): Minimum of 3-5 years’ relevant experience required, experience in Care Management is strongly preferred.
  3. Other: Position requires proof that candidate is an US citizen. The candidate must also obtain government security clearance and maintain letter of trustworthiness.

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal ability to furnish information. 41 CFR 630-1.35.

Application Instructions

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