CARE MANAGER in Chicago, IL at Beacon Health Options

Date Posted: 7/31/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Care Manager to join our team in IL.  This position is a remote offsite position.  The Care Manager is responsible to provide care management to Beacon members on an ongoing basis, within the members benefit package. The CM will initiate and maintain communication with members, Primary Care Physicians, Behavioral Health Providers and other health team members regarding care management plans to collaborate to meet members’ needs. The CM is responsible for conducting outreach, assessment, and care coordination/management for identified Medicare Medicaid Alignment and Integrated Care Program enrollees.  The CM works closely with Health Plan medical care managers, social care managers and other to ensure quality and effective service and support to members.

Position Responsibilities:

  • Complete comprehensive assessment of the medical, behavioral health and psychosocial needs of identified members and their families when delegated by the Health plan through the (HRA) process, enrollment and trigger reports, and other case identification sources, and establishingand implementing culturally competent care management plans to meet the needs of members.

  • Perform utilization management activities using Beacon level of care criteria and authorization standard operating procedures.

  • Create patient centered and culturally competent Individualized Care plan (ICP) to include problem identification, goal-setting, interventions and expected outcomes

  • Facilitate and coordinate the appropriate services and supports to meet the needs of enrollees, particularly high risk populations.

  • Provide health coaching and education to members related to health care conditions and treatment plans with a focus on medication and treatment adherence, appropriate use of emergency room, and navigation of the health care system.

  • Direct members to self-management tools and resources and support in their use.

  • Collaborate with medical and social care managers and Pharmacy to develop a comprehensive and integrated approach to care coordination.

  • Participate in rounds forums to promote integrated case discussions and problem-solving

  • Make timely referrals for community based services.

  • Document care management activities in FlexCare and /or Health Plan Electronic Health Record according to Beacon Standard Operating Procedures.

  • Record utilization management decisions in FlexCare and /or Health Plan Electronic systems according Beacon Standard Operating Procedures

  • Complete care and utilization management activities in a timely manner and meet compliance requirements for the state Medicaid regulatory HSAG, Medicare NORC, NCQA, and Beacon Clinical Management department standard operating procedures.

  • Demonstrate flexibility and creativity in the design of innovative and individualized care plans in order to achieve maximum effectiveness and optimal outcomes for members and their families.

  • Participate in member/family meetings to support integrated efforts and collaboration with the health care team

  • Provide assistance, advocacy, and empowerment to members in efforts to achieve optimal health

Position Requirements:

Education:      

  • Master’s level behavioral health professional required.

Licenses:

  • Current, valid and independent unrestricted license as a LCSW, LCPC, Clinical Psychologist, RN

Relevant Work Experience:   Requires three to five years’ experience working with mental health/substance use disorders and/or developmental disabilities. Must be familiar with DSM-5 diagnostic framework and conducting diagnostic assessments. Prior experience completing PASRR reviews preferred.  One to three years’ supervisory experience is preferred.

Knowledge, Skills & Abilities:

  • At least 3 years’ experience with SMI population in acute care settings, or case management programs

  • Strong organization skills, ability to multi-task, and proficiency in Word, Excel, and PowerPoint required.

  • Illinois Integrated Care Program, Medicare and Medicaid, Waiver and Consent decree experience highly preferred.

  • Excellent communication skills (verbal and in writing).

  • Experience working with individuals of different cultural and ethnic backgrounds preferred.

  • Ability to manage multiple priorities and work collaboratively within a team environment required. Managed care experience with familiarity with Medicaid and Medicare populations preferred

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

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

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