Creole - Clinical Case Manager, Behavioral Health - Miami FL

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Requisition Job Description

Summary: 

The Clinical Case Manager, Behavioral Health/SMI is a field based role with up to 40% travel within the Miami-Dade and Monroe counties. The SMI Clinical Case Manager, is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating) for a Seriously Mentally Ill (SMI) population.  The CCM, SMI, utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member behavioral and physical healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. 

Position Responsibilities: 

• Responsible for telephonic and/or face to face assessment, planning, implementing and coordinating care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member’s overall wellness. 
• Develops a proactive course of action to address issues presented and facilitate short and long-term outcomes as well as identify opportunities to enhance a member’s overall health through integration. 
• Through the use of clinical tools and information/data review, conducts comprehensive assessments of member’s needs and recommends an approach to case resolution by meeting needs in alignment with their benefit plan and available internal and external programs and services.  
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical and social indicators which impact care planning and resolution of member issues.  
• Completes assessments that take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and the member’s restrictions/limitations. 
• Analyzes utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.  
• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.  
• Provides crisis follow up to members to help ensure they are receiving the appropriate treatment and services. 
• Applies and interprets 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. 
• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access. 
• Using holistic approach consults with managers, medical directors and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives/ 
• Presents cases at case conferences/rounds to obtain multidisciplinary view in order to achieve optimal outcomes. 
• Works collaboratively with the members’ interdisciplinary care team. 
• Identifies and escalates quality of care issues through established channels.  
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.  
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and  conversation. 
• Provides coaching, information