Clinical Case Manager Behavioral Health - Arizona

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Position Summary
The Behavioral Health Coordinator is a full time work from home position. This position is a primary point of contact to provide Plan-level leadership in working with behavioral health providers and other member-serving agencies involved to address barriers to crisis and other behavioral health care raised by members, family members and adoptive parents; working collaboratively with network managers to reduce out-of-state placements; referral assistance; and is actively involved in managing out-of-state placements.
This position utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Fundamental components:

• Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.

Enhancement of Medical Appropriateness and Quality of Care:

• Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
• Using holistic approach consults with supervisors,Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

Monitoring, Evaluation and Documentation of Care:

• In collaboration with the member and their care team, develops and monitors established plans of care to meet the member’s goals.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

• Must reside in Arizona
• Behavioral Health clinical license in the state of Arizona (eg., LCSW, LMSW, LPC, LAC, LMFT, LAMFT)
• 3+ years of direct clinical practice experience post Master’s degree, e.g., inpatient or outpatient behavioral health setting
• 1+ years of experience working with and navigating Arizona DCS state welfare system, resources, and programs
• 1+ years computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel
• Ability to travel in state with a personal vehicle up to 10% of the time. Qualified candidates must have a valid AZ driver's license, reliable transportation, and proof of vehicle insurance

Preferred Qualifications

• Understanding and/or experience with higher levels of care including residential facilities, out of home behavioral health treatments, and inpatient hospitalization
• Experience working with pediatric populations
• Case management and discharge planning experience
• Managed care experience

Education

• Minimum of a Master's degree in Behavioral/Mental Health or related field required

Anticipated Weekly Hour