Fully remote (never coming onsite)This role is working remotely, this position will require travel to meet in person with members around Service Delivery Area 75% of the time.Description:Care Manager Behavioral HealthPosition SummaryUtilizes 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 psycho social wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.Assessment of Members: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.- 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.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.- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.- Helps member actively and knowledgeably participate with their provider in healthcare decision-making- 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 proceduresContact with Members:Through the use of service coordination 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.Completes face to face visits and monthly phone contact with members, utilizing various treatment modalities and interventions to achieve desired goals for members-Applies judgment to the incorporation of strategies designed to reduce risk factors and address indicators which impact care planning and resolution of member issues while aware of member diagnosis.Utilizes motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health.Required QualificationsDirect clinical practice experience post masters degree, e.g.,hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.Minimum of a Master's degree in Behavioral/Mental Health or related field.75% travel required to meet in person with members in Tarrant or Dallas counties and surrounding areasUnencumbered Behavioral Health clinical license in the state where they work (LCSW, LPC, LMSW)Preferred QualificationsField ExperienceBilingualCrisis intervention skills preferred.Managed care/utilization review experience preferred.Case management and discharge planning experience preferred.EducationLicensed master level clinician required, degree being social work or counselingDutiesComplete comprehensive assessments with members and families, creating an individual service plan to meet member's needs, complete in person visits, monitor member's progress and assess member needs through telephonic review.ExperienceMinimum 2 years of relevant experienceNotes:Days and HoursMon-Friday 8:00-5:00pm, may require flexibility outside those hours based on member preferenceFully remote (never coming onsite)This role is working remotely, this position will require travel to meet in person with members around Service Delivery Area 75% of the time.VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status
Description:Care Manager Behavioral HealthPosition SummaryUtilizes 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 psycho social wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.Assessment of Members: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.- 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.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.- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.- Helps member actively and knowledgeably participate with their provider in healthcare decision-making- 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 proceduresContact with Members:Through the use of service coordination 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.Completes face to face visits and monthly phone contact with members, utilizing various treatment modalities and interventions to achieve desired goals for members-Applies judgment to the incorporation of strategies designed to reduce risk factors and address indicators which impact care planning and resolution of member issues while aware of member diagnosis.Utilizes motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health.Required QualificationsDirect clinical practice experience post masters degree, e.g.,hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.Minimum of a Master's degree in Behavioral/Mental Health or related field.75% travel required to meet in person with members in Tarrant or Dallas counties and surrounding areasUnencumbered Behavioral Health clinical license in the state where they work (LCSW, LPC, LMSW)Preferred QualificationsField ExperienceBilingualCrisis intervention skills preferred.Managed care/utilization review experience preferred.Case management and discharge planning experience preferred.EducationLicensed master level clinician required, degree being social work or counselingDutiesComplete comprehensive assessments with members and families, creating an individual service plan to meet member's needs, complete in person visits, monitor member's progress and assess member needs through telephonic review.ExperienceMinimum 2 years of relevant experienceNotes:Days and HoursMon-Friday 8:00-5:00pm, may require flexibility outside those hours based on member preferenceFully remote (never coming onsite)This role is working remotely, this position will require travel to meet in person with members around Service Delivery Area 75% of the time.
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