Job Description
The Behavioral Health Case Manager coordinates appropriate care, resources and/or services of selected member populations. Provides guidance and promotes effective utilization and monitoring of behavioral health care resources to drive quality care for our members. Collaborates as needed with varied members of the healthcare team to achieve optimal clinical and/or resource outcomes.Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to achieve optimal clinical and resource outcomes.
Utilize applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, appropriate intervention and/or discharge planning.
Develop a member-centric plan tailored to members’ needs, behavioral health status, educational status and level of support needs; identify barriers to meeting goals or plan of care
Utilize community resources and funding sources as needed in the development of the plan of care.
Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.
Evaluate and facilitate care provided to members through the continuum of care (office-based, outpatient, inpatient, residential, etc.).
Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes
Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
May outreach directly to members identified as high risk, high cost, or high utilization cases.
May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.
May evaluate medical necessity and appropriateness of services as defined by department.
As needed, develop relevant policies/procedures, education or training for use both internally and externally.
Hiring Requirements
RN or LCSW with 3 years of clinical and/or case management experience required. For some roles a Master's in Social Work with 5 years of related experience may be considered.
For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.
Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
For some roles, additional specialty certification (i.e. CCM, CDCES) may be required. If so, incumbents must obtain relevant certification within 2 years of employment.
Nice to haves
Proficient in Microsoft Office
Medicare and Medicaid experience preferred
Strong Behavioral Health Skills
Utilization Management Experience
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
In The Network
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Moderna
