The Behavioral Health Care Manager is responsible for providing care management and care coordination for adult and/or adolescent patients with moderate to complex illness or behavioral health needs, in the primary care setting, under minimal supervision. Serves in an expanded health care role to collaborate with a multidisciplinary care management team, psychiatric consultant, and patients/families to ensure the delivery of quality, efficient, and cost-effective health care services. Assesses care plans, implements, coordinates, monitors, and evaluates all options and services with the goal of optimizing the patient’s health and emotional status. Integrates evidence-based clinical guidelines, preventive guidelines, and protocols, in the development of individualized care plans that are patient-centric, promoting quality and efficiency in the delivery of health care.
Responsibilities and Duties
- Manage and Actively Follow a caseload of patients identified for behavioral health opportunities
- Provides targeted interventions to avoid hospitalization and emergency room visits
- Coordinates care across settings and helps patient/families understand health care options
- Provides appropriate and timely intervention post PCP referral on Behavioral Health need
- Follows patient health, emotional status, and psychosocial needs of the patient/family using standard assessment tools
- Collaborates with PCP, patient, and members of the health care team, including psychiatrist.
- Develops a comprehensive individualized plan of care and targeted interventions and continually monitors patient/family
- Provides patient self-management support with a focus on empowering the patient/family to build capacity for self- care.
- Implement systems of care to facilitate close monitoring of high-risk patients including those with Behavioral Health needs
- Implements clinical interventions and protocols based on evidence-based clinical guidelines.
- Coordinates patient care through ongoing collaboration with PCP, Psychiatrist, patient/family, community, and other members of the health care team.
- Provides follow-up with patient/family when patient transitions from one setting to another in a timely manner
- Demonstrates excellent written, and communication skills, positive relationship building skills, and critical analysis skills.
- Maintains required documentation for all care management activities using Athena EHR.
· Counsels and educates clinical staff on billing compliance to ensure accurate and timely submissions of claims to maintain program integrity.
· Provides daily oversight of hospital and skilled nursing facility admission and discharge feed. Communicates, and coordinates needed care management services for patients engaged in Care Management Services.
· Responds to telephonic inquiries from patients, practices, and payers.
· Coordinates and communicates important program elements and changes to the care management team and primary care practices to supports the ongoing relationship with primary care practices engaged in care management services.
· Ensures the program maintains compliance with HIPAA and related information security policies, ensures safekeeping of confidential information.
· Other duties as assigned.
Qualifications
- Current Michigan Registered Nurse (BSN preferred), Master of Social Work License, Licensed Mental Health/ Professional Counselor, or Licensed Psychologist
- Behavioral Health specialized training or experience in behavioral health in past 5 years
- Three years of experience with adult medicine and pediatric patients in primary care/ambulatory care, home health agency, skilled nursing facility, or hospital medical-surgical setting, within the past five years
- Knowledge of chronic conditions, evidence-based guidelines, prevention, wellness, risk assessment, and patient education
- Critical thinking skills and ability to manage complex clinical issues utilizing assessment skills and protocols
- Excellent assessment / triage skills with the ability to implement evidence base interventions and protocols
· Excellent written and oral communication skills required.
· Experience working in a multi-cultural setting.
· Ability to initiate and maintain positive working relationships with United Physician staff and other organizations.
· Understand program initiative facilitated by United Physicians.
· Ability and willingness to provide patient education, support, and motivation to patients regarding their care management benefits.
· Care management and patient self-management training consistent with local standards
· Knowledgeable of multiple electronic medical records applications
· Knowledge of CPT billing codes
· Valid driver’s license and reliable transportation
· Must be proficient in Microsoft Office and email communication
Performance Skills
· Team player
· Able to engage patients, family, caregivers, other members of the Care Management team and the client practice PCMH team in a common understanding of each patient’s individual plan for health
- Time management, organizational and prioritization skills
· Sensitive to cultural, linguistic, and psychosocial barriers to successful self-management and implementation of the individual care management plan
· Creates sense of empowerment on the part of patients, family, and caregivers
· Manages multiple and conflicting priorities
· Able to resolve customer inquiries and complaints in a timely manner, consistent with corporate policy
Extroverted personality that enjoys interacting with new people from different backgrounds
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Medical specialties:
Schedule:
Work Location: Remote