Behavioral Health RN Case Manager, RN

Imagine360 is seeking a Behavioral Health RN Case Manager to join the team!  The Behavioral Health RN Case Manager is responsible for delivering case management services to individuals covered by group health plans administered by imagine360, drawing on nursing education, clinical experience, and professional judgment. The RN is a case manager serving patients with medical, behavioral health, mental health, and/or neurodevelopmental disorder needs. They adhere to department criteria, collaborating with physicians, providers, members, and other stakeholders to assess, plan, coordinate, monitor, evaluate, and advocate for necessary options and services to address comprehensive health needs of individuals and families. They leverage communication and resources to enhance quality and cost-effective outcomes, acting as a liaison to providers, physicians, and members. The RN will receive member referrals from non-Behavioral Health Case Managers and Disease Management clinicians to support the Behavioral Health needs of those members. The Registered Nurse operates within the scope of nursing practice while fulfilling these responsibilities.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Identify, collect, process, and manage data to perform the Case Management process by utilization Imagine360 approved clinical guidelines and following Medical Management Policy and Procedures
• Conducts comprehensive clinical assessments according to established policies and procedures to identify and provide appropriate care and coordination of behavioral health, mental health, neurodevelopmental disorder diagnoses.
• Manage members with behavioral health, mental health, neurodevelopmental disorder diagnoses, and for members with medical diagnoses that also have behavioral health, mental health, neurodevelopmental disorder diagnoses.
• Utilize clinical knowledge, expertise, and educational resources to provide verbal and/or written educational resources to members regarding diagnosis, procedures and/or treatment.
• Assess the need for and collaborate with community resources for members in case management.
• Uses assigned software accurately to document and complete all steps of review of medical necessity and case management processes, including time slips.
• Facilitate the Patient Satisfaction Surveys
• Assess for cost savings and document the cost savings in assigned software platform.
• Appropriately escalates complex cases to Supervisor, IDCT, or designee as needed.
• Performs essential activities of case management while maintaining members' confidentiality, safety, advocacy, adherence to ethical, legal, accreditation and regulatory standards.
  • Performs assessments of each member to identify Case Management needs.
    • Consistently exercises discretion and judgment to analyze, interpret, make deductions, and then decide what actions are necessary based on the varying facts and circumstances of each individual case.
  • Determines measurable goals utilizing motivational interviewing and behavior change model and coaches' clients while monitoring self-care practices.
    • Utilizes industry standard tools to guide individuals with chronic/ongoing health conditions through coaching, assessments, listening, and other techniques as appropriate.
  • Executes activities or interventions to achieve the goals in the plan.
  • Organizes, integrates, and modifies the resources needed to reach the goals in the plan.
  • Monitors all information from all relevant sources in the plan and its activities and services to