Conducts comprehensive member psychosocial assessments through root cause analysis and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs. Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Assess members to recommend activities and behavioral routines to meet the social and medical needs of members and their families. Provides support and/or intervention and assists members in understanding the implications and complexities of their current medical situation and/or overall personal care.
REPORTS TO: SR. MANAGER, FOSTER CARE ADOPTION & GUARDIANSHIP
DEPARTMENT: KENTUCKY HEALTH SERVICES- STATE
POSITION LOCATION: LOUISVILLE, KY 40223 OR LEXINGTON, KY 40509
- Assesses, plans, implements, monitors and evaluates options and services to meet complex psychosocial health needs of inpatient and outpatient members.
- Manages a caseload in compliance with contractual obligations and WellCare standards.
- Conducts comprehensive member assessments through root cause analysis based on referred member's needs and benefit plan eligibility, and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs.
- Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability.
- Works towards achievement of optimal clinical and resource outcomes.
- Monitors and evaluates effectiveness of care plan and modifies plan as needed.
- Supports member access to appropriate quality and cost effective care.
- Coordinates with internal and external resources to meet identified needs of the member's care plan and collaborates with providers.
- Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
- Provides clinical consultation to physicians, professional staff and other teams members/supervisors to provide optimal quality patient care and effective operations.
- Interacts continuously with members, family, physician(s), and other resources to determine appropriate behavioral action needed to address medical needs.
- Reviews benefits options, researches community resources, trains/creates behavioral routines and enables members to be active participants in their own healthcare.
- Ensures members are engaging with their PCP to complete their care management treatment plan or preventive care services.
- Assists in obtaining benefits for members through community resources when benefits are exhausted or not available.
- Performs other duties as assigned.
- 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 is required
- 2 years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning is required
- 1 year of experience in current case management as a licensed professional is required
- Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs is required
- Experience in a managed care environment is preferred
Licenses and Certifications:
- Ability to work independently, handle multiple assignments and prioritize workload
- Ability to multi-task
- Demonstrated time management and priority setting skills
- Demonstrated interpersonal/verbal communication skills Communicates effectively in person and by phone
- Ability to create, review and interpret treatment plans
- Ability to effectively present information and respond to questions from families, members, and providers
- Knowledge of healthcare delivery
- Knowledge of community, state and federal laws and resources
- Demonstrated written communication skills
- Demonstrated customer service skills
- Ability to effectively present information and respond to questions from peers and management
- Demonstrated problem solving skills
A license in one of the following is required:
- Master's level independent or non-independent license is required OR is required
- Licensed Clinical Social Worker (LCSW) LSW, LCSW, LMHC, LPC, LMFT, PsyD is required
- Licensed Clinical Mental Health Counselor (LCMHC) is required
- Licensed Clinical Professional Counselor (LCPC) is required
- Licensed Clinical Marriage & Family Therapist (LCMFT) is required
- Licensed Clinical Psychologist (LCP) is required
- Licensed Master Social Work (LMSW) is required
- Certified Social Worker (C-SW) is required
- Proficient in Microsoft Office including MS Outlook, MS Word and MS Excel is required
- Knowledge of or the ability to learn company approved software such as EMMA, CRMS, Peradigm, InterQual, Sidewinder and other software in order to perform job duties is required
- Required Intermediate Healthcare Management Systems (Generic) is required *LI-RG1