Clinical Care Manager in Bridgewater, MA at Beacon Health Options

Date Posted: 12/13/2019

Job Snapshot

Job Description

We are currently seeking a dynamic Clinical Care Manager to join our team at our office in Bridgewater, Massachusetts. 

The Clinical Care Manager is responsible for triage and management of members referred to our case management program.  The Clinical Care Manager is also responsible for the tracking and managing of members identified for case management who may be high utilizing, at significant risk, or under-utilizing services.  The Clinical Care Manager also maintains relationships within the provider community to expedite our member’s access to clinically appropriate services, thereby improving member outcomes.  The Clinical Care Manager performs telephonic outreach to members to assist in identifying needs and barriers as well as in-person outreach as appropriate and assigned.  Work with members includes, but is not limited to completing a comprehensive assessment, individualized care plan and work with the member to aid in the understanding and utilization of services available to them within the continuum of care. This position will facilitate tracking all necessary quality indicators to meet necessary accrediting bodies (i.e. NCQA and URAC)

What does a typical day look like?

Outcomes:

  • Contribute to the total team caseload management.
    • Maintain an active member caseload of no less than 50 members at any given point in time
    • Completion of a comprehensive assessment within 30 days of referral
    • Appropriate assessment of member acuity for appropriate intervention scheduling
    • Coordination with team members and supervisor on any issues with caseload maintenance
  • Contribute to the team Engagement rate goal of >=20%
    • Upon receipt of referral, attempt to outreach within 1 business day to member or facility
    • Upon notice of discharge, attempt to outreach member within 1 business day
  • Maintain active community presence in assigned community activities, which may include:
    • Onsite presence at local hospitals to meet with and engage members.
    • Training of staff and community members on program
    • Training with new nursing staff at our co-located plan office on referrals to care management
    • Conduct training with local community agencies and hospitals on communication strategies

Other Responsibilities: 

  • Coordination with plan medical case management and utilization management staff on referrals and member concerns
  • Attend all assigned meetings, trainings and conference calls as scheduled and on time
  • Contribute to no less than bi-weekly individual and bi-weekly team supervision and meetings
  • Perform customer services aspects as required and conduct business in a professional manner.
  • Troubleshoot member issues with provider access, claims, and other needs as determined. Investigate and research to resolve customer problems and issues in a timely and satisfactory way.
  • Comply with all Beacon policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards;
  • Assists with NCQA, URAC and other QI initiatives;
  • Apply Beacon Health Options policies and procedures consistently.
  • Maintain confidentiality of clients, business records and reports.
  • Maintain ethical and professional standards.
  • Meet all productivity, performance and departmental standards and expectations.
  • Complete all tasks accurately, appropriately and within required timeframes.
  • Other duties as assigned;

What you Contribute?

Education: Master’s Degree or higher or RN required

Licensure: Current valid and unrestricted license in a in a mental health field (RN, Ph.D, LMSW/LCSW, MHC, LLP, LPC, etc.) required. Re-verification will take place no less than every 3 years.

Knowledge, Skills & Abilities:

  • Strong verbal and written communication skills.
  • Behavioral health experience and understanding of mental health and substance use services, managed care as well as current principles, procedures and knowledge domains of case management, Wraparound and Community-Based Services.
  • Good analytic skills and be comfortable working with metrics and data
  • Strong organizational skills
  • A high level of ability to work well under pressure and multi-task between multiple priority items
  • Works well in a fast paced environment as well as have excellent problem solving skills
  • Proficiency in Word, Excel needed and PowerPoint preferred.

What Makes Us Different?

  • Here, it’s not just a job – it’s an opportunity to change lives.
  • Our employees are learners, innovators and original
  • Our mission and values guide the way we treat our members, providers and each other.

What We Have to Offer:

  • Healthcare benefits available starting day 1!
  • Health & wellbeing incentives, such as gym membership reimbursement
  • 401K with company match to help reach your future financial goals
  • Generous PTO, because we know life happens outside of work
  • Tuition reimbursement so you can keep reaching your fullest potential

If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

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