Counselor - netPolarity, Inc. (Saicon Consultants, Inc.) : Job Details

Job details are Shared below:

Job Title: Care Manager

Location:100% Remote

Job Duration: 4+m Contract with potential for conversion

Primary Skills:

• Experience in Care management
• Triage experience for mental health and substance health
• Experience with utilization management, utilization review, applying medical necessity criteria, high level of care utilization review, conducting or completing prior authorizations and completing concurrent reviews (CCR).
• Certifications Required (anyone) - LCSW - Licensed Clinical Social Worker, LMFT - Licensed Marriage and Family Therapist, LMSW - Licensed Master Social Worker, LPC - Licensed Professional Counselor, RN - Registered Nurse, State and/or Compact State Licensure.
• Working On a que
• Care management experience
• Proficient Typing skills
• Microsoft office experience
• MCG knowledge
• TrueCare and IP system experience

Nice To have:

• DSM and ASM knowledge

Responsibilities:

• Possess clinical knowledge, understand best practices and continuous learning skills, review member records, and work in conjunction with primary care, community benefits, and other support opportunities to develop a long term care plan to guide the member through their mental health care
• Oversee the work of assigned care support team and work with non-licensed support staff to meet standards of care and performance set by Member Market Leads and the Care Management Center of Operational Excellence (CoOE) Lead
• Accountable for all Care Management activities for assigned high and moderate members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple clinical, social, and community resources
• Provide telephone triage, crisis intervention and prior authorizations as assigned for select members stratified as high and moderate member need
• Conduct in depth health risk assessment and/or comprehensive needs assessment including, but not limited to, psycho-social, physical, medical, behavioral, environmental, and financial parameters
• Develop, document, implement, and communicate the patient-centered care plan, which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs
• Educate providers, supporting staff, members and families regarding care management role and health strategies with a focus on member-focused approach to care
• Serve as an accountable member of the care team to oversee appropriate rendering of services (e.g., during transitions in care or transition to home care, back up plans, community-based services)
• Oversee and effectively manage work assigned and conducted by assigned care support team
• Implement, coordinate, and monitor strategies for members and families to improve health and quality of life outcomes
• Act as an advocate for members' care needs by identifying and addressing gaps in care
• Perform ongoing monitoring of members' care plan and measure the effectiveness of interventions as identified; develop plans that strive to meet Magellan developed KPIs in accordance with the CM CoOE Lead and Member Market Leads
• Assess and review plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes
• Work with members and the interdisciplinary care plan team to adjust plan of care as necessary
• Facilitate a team approach, including all participants of the Interdisciplinary Care Plan team, Health Plan Medical Care Management where appropriate, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.
• Start time: 9 or 9:30a CST
• End time: 5:30p or 6pm
• 30-minute unpaid lunch breaks

Summary:

• This position is responsible for the assessment, reassessment, care planning and coordination of care and services including ongoing monitoring of an appropriate and effective person-centered care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity criteria. Responsible for the development of individualized care plans for high and moderate stratified members in the Medicaid, Medicare, and Whole Health markets.

Qualification:

• Bachelor's degree or relevant experience.

Please respond at the earliest to speed up the interview process. I will contact you if I need further details.

Amit Bundele

Technical Recruiter

Phone : 669-###-####

Email : [email protected]

San Jose, California

www.netpolarity.com