Position Purpose: Perform duties related to the day-to-day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members’ current functional level and, in collaboration with the member, develop and monitor the Case Management Care Plan, monitor quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the Integrated Case Management functions. Collaborate with both medical and behavioral providers to ensure optimal care for members.

Position Responsibilities:

• Work telephonically with patients identified as high risk, for both behavioral and physical health issues, and their providers to identify needs, set goals and implement action steps towards achieving goals. Empower patients to help them improve their quality of life and ensure an integrated approach to address complex issues.
• Understand and comply with NCQA guidelines and HEDIS measures.
• Comply with established referral, pre-certification and authorization policies, procedures and processes by related Medical Management staff.
• Participate in on-going communication between case management staff, utilization management staff, health plan partners and contracted providers to address the complex issues related to both behavioral and physical health issues.
• Monitor/bridge communications between behavioral health and physical health providers to ensure comprehensive care services for complex issues.
• Assist with the implementation of policies and procedures regarding case management and utilization management functions.

Knowledge/Experience: Thorough knowledge of a specialized or technical field such as clinical nursing, case and/or utilization management involving knowledge plus the application of basic theory. Master’s degree in behavioral health and an unrestricted license as a LCSW, LMFT or LPC, or a PhD, PsyD or RN with experience in psychiatric and medical health care settings. Knowledge of utilization review procedures, and familiarity with mental health community resources. 3-5 years of case and/or utilization management experience.

Licenses/Certifications: Unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN license in applicable state.

Abe Ghebrehiwet
Senior Account Executive
Nurse Resolutions
888.411.2228. X 204 Toll Free
407.341.9647. Cell
407.982.7508. Fax
www.NurseResolutions.com

Behavariol health, mental, psychiatric, case manager, LCSW, LMFT, LPC, PhD, PsyD , RN, Oak Brook, Illinois, managed care, job openings