Position Summary
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues

The client is hiring for multiple openings across the state/regions. Intensive Case Manager utilizes critical thinking and professional judgment to support the case management process, in order to facilitate and maintain improved healthcare outcomes for members by providing advocacy, collaboration coordination, support and education for members through the use of care management tools and resources.

Evaluation of Members:

- Through the use of care management assessments and information/data review, recommends an approach to resolving care needs maintaining optimal health and well-being by evaluating member’s benefit plan and available internal and external programs/services.
- Identifies high risk factors and service needs that may impact member outcomes and implements early and proactive support interventions.
- Coordihonic positionnates and implements Wellness care plan activities and monitors member care needs.

Enhancement of Medical Appropriateness and Quality of Care:

- Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
- Identifies and escalates quality of care issues through established channels.
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote 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 knowledgably participate with their provider in healthcare decision-making.

Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications :

- Minimum 6 months experience in Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services or evidence-based practices applicable to the Kentucky SKY populations, is required.
- Minimum 2 year of experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
- Minimum 1 year of experience in MS Office Suite applications, including Word and Excel.
- Willing and able to travel 80-90% of their time to meet members face to face in their assigned region.


Preferred Qualifications

- 3+ years' experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
- 1+ MCO experience.


Duties
Determines medical necessity/ appropriateness
Facilitates optimal outcomes
Identifies and follow through with continuous quality/ compliance opportunities . May also include identification of aberrance's and initiation of corrective action
Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy
Optimize total costs
Implementation and evaluation of policy based on usage and program directives
Educate/empower colleagues at all levels to enable decision making at most appropriate level?

Experience
- Minimum 5 years of relevant experience

Education
Bachelor's degree in relevant subject



Notes:
safety sensitive
M-F 8am-5pm with the flexibility to work until 7PM in the field EST.