Job ID: 51684
Location: San Jose, CA
Category: General Business, Nurse, Management, Health Care
Experience: Not Specified
Education: See Requirements
Ability to work from home 2 days out of the week
ABOUT THE POSITION
We are currently seeking a dynamic Care Manager Team Lead to join our team at our office in San Jose, CA. The Care Manager Team Lead must hold a valid CA Clinical License and will be responsible for provides comprehensive management of the Case Management Team and facilitates the delivery of the highest standards for the Case Management Program, quality outcomes and operational efficiencies.
Leads the Case Management Team by directing the activities of team members, drawing upon referral criteria and clinical expertise to manage all aspects of Case Management
Assists with the design, development, modification, of workflows for the Case Management Team.
Supports the development of solutions for issues and presents recommendations to the Clinical Manager and/or Clinical Director.
Assist in establishes goals and objectives for the CM Team and individual team member roles and responsibilities.
Possesses and maintains in-depth knowledge of workflows, products, program components.
Troubleshoots for problems and submits recommendations. May be required to interface with other areas, either internally or externally, to effectively resolve problems.
May provide direct supervision of staff, including performance reviews.
Work collaboratively to coordinate a supportive environment and clear communication;
Maintaining accurate information in Beacon’s clinical documentation systems as directed
Assist in collection of outcomes information, annual analysis and other reporting and initiatives
Telephonic collaboration with provider and county agencies regarding members in care management
Participation in systems meetings as needed
Collaborate with Primary Care Physician (PCP), Behavioral Health Professionals (BHP), and other members of the health care team, including health plan medical care managers, Pharmacy, and others to arrange and coordinate services for the member and optimize the member’s ability to engage in the appropriate plan of care;
Developing or overseeing a plan of care for each assigned member, adhering to timelines and including assessment of health needs, individualized care management plans, implementation, monitoring and evaluation of care outcomes;
Assist with NCQA and URAC initiatives
Telephonic collaboration with Members
Treatment Record Reviews
Attend Clinical meetings
Other duties as assigned
Education: Master’s degree or higher in a health related field and licensure as a behavioral health professional.
Licensure: LMFT, LICSW, LCSW, RN, LMHC
*Work from home 2 days out of the week
Relevant Work Experience:
Current, valid and unrestricted licensure for independent practice required with proof on date of hire. Re-verification will take place no less than every 3 years. A minimum of LMFT, LICSW, LCSW, RN, LMHC, with 5-7 years combined direct behavioral health, supervisory and/or managed care experience required.
Knowledge, Skills & Abilities:
Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes.
Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up.
Educated in current principles and procedures of behavior health care.Knowledge of managed care and state specific expertise preferred.
Strong interpersonal skills and good written and verbal communication skills.
Advanced computer skills required, including working knowledge of MS Office: Word, Excel, and PowerPoint
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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled