Clinical Case Manager, Transitions of Care, Behavioral Health

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Position Summary

This is a full-time field-based teleworker opportunity in Oklahoma.

Qualified candidates preferably will reside within the region which includes the following counties:

Harmon, Greer, Jackson, Kiowa, Comanche, Caddo, Cotton, Grady, Stephens, Jefferson, Cleveland, McClain, Garvin, Murray, Carter, Lowe, Marshall, Johnston, Pottawatomie, and Lincoln.

Typical working schedule: Monday - Friday 8am-5pm.

Responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). 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 wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes.

• Responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all care management activities with members to evaluate the medical and behavioral health needs to facilitate the member’s overall wellness.
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
• 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.
• Completes assessments taking into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and include the member’s restrictions/ limitations.
• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical 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/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.
• Using holistic approach consults with manager, 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 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 and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Analyzes utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
• 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.
• Facilitates clinical hand offs during