Mgr, Behavioral Health**

Oversees the day-to-day operations of behavioral case management as it relates to the psychosocial, socioeconomic needs and services of select member populations across the continuum of care. Ensures team is compliant with all Model of Care regulatory requirements and produces optimal clinical, socioeconomic, psychosocial and resource outcomes. Ensures the inpatient and outpatient case management process of assessing, planning, implementation, monitoring, and evaluating services and outcomes is pursued to maximize the health of the member with high acuity psychosocial needs and/or behavioral health conditions.

Department: Health Services

Reports to: Dir. Field Care Manager

Location: Jacksonville, FL

Essential Functions:

  • Works directly with staff and members to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member. Implements utilization and/or case management workflows and policies and procedures for integrated behavioral health programs.
  • Proactively monitors appropriate metrics to drive efficiency.
  • Provides leadership and support to front-line staff and supervisors of behavioral health services in the assigned market(s) or state.
  • Provides recommendations and support to behavioral health leadership for future expansion and growth efforts.
  • Serves as an instrumental partner in monitoring and tracking key performance indicators to include identification of over/under utilization and/or case management patterns and/or deviation from expected results for assigned market(s) or state.
  • Assists with development of clinically-focused training associated with behavioral health assessment, care plan development and behavioral health services in the market(s) or state.
  • Performs audits of assessments, case plans and service notes to verify cases are properly established and that member coordination activates are occurring and appropriately documented.
  • Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history, mental health history and current status. Assesses the options for care including use of benefits and community resources to update the care plan and coordinate services.
  • Act as a liaison and member advocate between the member/family, physician and facilities/agencies.
  • Provides training and guidance to new and current behavioral health associates regarding policy and procedure, systemic tools, workload and care plan development.
  • Ensures regulatory requirements and accreditation standards are applied to all activity and reporting.
  • Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.
  • Function as subject matter expert for behavioral health processes, mental health services and psychosocial programs.
  • Performs other duties as assigned
Additional Responsibilities:
    Candidate Education:
    • Required A Master's Degree in Social Work, Psychology, Counseling, Rehabilitation, or other relevant field that provides a foundation to receive a license as required of the position
    Candidate Experience:
    • Required 5 years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning
    • Required 1 year experience in leading/supervising others
    • Required 3 years of experience in a managed care environment (as a licensed mental health professional )
    • Required Other Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
    Candidate Skills:
    • Intermediate Ability to communicate and make recommendations to upper management
    • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
    • Intermediate Demonstrated time management and priority setting skills
    • Intermediate Ability to multi-task
    • Intermediate Ability to lead/manage others
    • Advanced Ability to create, review and interpret treatment plans
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Demonstrated problem solving skills
    • Intermediate Knowledge of community, state and federal laws and resources
    • Intermediate Demonstrated written communication skills
    • Intermediate Demonstrated customer service skills
    • Advanced Knowledge of healthcare delivery
    Licenses and Certifications:
    A license in one of the following is required:
    • Other One of the following is required:
    • Required Licensed Clinical Social Worker (LCSW)
    • Required Licensed Clinical Mental Health Counselor (LCMHC)
    • Required Licensed Clinical Marriage & Family Therapist (LCMFT)
    • Required Licensed Clinical Professional Counselor (LCPC)
    • Required Licensed Clinical Psychologist (LCP)
    Technical Skills:
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft Excel
    • Required Intermediate Healthcare Management Systems (Generic)
    • Required Intermediate Microsoft Outlook
    Languages:
    • Preferred Other Bilingual skills

    About us
    Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.