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

Utilizes critical thinking and judgment to collaborate and inform the case management process to facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education for members using care management tools and resources.
Uses care management tools and information to evaluate members, conducts comprehensive evaluation of member’s needs/eligibility, and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
Identifies risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
Coordinates and implements assigned care plan activities and monitors care plan progress.?
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 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 members’ benefits and healthcare needs.
Utilizes 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 members to make ongoing independent medical and/or healthy lifestyle choices.
Helps members 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?
Bachelor’s degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling), LMHP, RN/LPN, QMHP, LMSW, LBSW, MSW or BSW
2 years’ experience in behavioral health, social services, or appropriate related field equivalent to program focus
Up to 70% of travel will be required in assigned region?

Preferred Qualifications?
Case management and discharge planning experience preferred
Managed Care experience preferred

Notes:

Mon-Fri 8am-5pm No nights, no weekends, no holidays and no on-call