DESCRIPTION: Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources. This role promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction.
Conducting in depth health risk assessment and/or comprehensive needs assessment which include, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
Communicating and developing the treatment plan for authorization of services, and serves as a point of contact to ensure services are rendered appropriately, (i.e. during the transition to home care, back up plans, community-based services).
Implementing, coordinating, and monitoring strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for members care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan.
Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes; collects clinical path variance data that indicates potential areas for improvement of care and services provided; works with members and the interdisciplinary care plan team to adjust the plan of care, when necessary.
Educating providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on a member-focused approach to care. Facilitates a team approach to the coordination and cost effective delivery to quality care and services.
Facilitates a team approach, including the Interdisciplinary Care Plan team (ICPT), to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member’s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community-based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases.
Provides assistance to members with questions and concerns regarding care, providers or delivery system.
Maintains a professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
Generates reports in accordance with care coordination goals.
Complies with Case Management Society of America Standards for Case Management Practice and with CCMC code of Professional Conduct for Case Managers.
Assists with orientation and mentoring of new team members as appropriate.
Candidates with a dual license in MD& DC or MD & VA who resides in MD will have preference over candidates who are ONLY licensed in MD.
All candidates submitted to this req will reside on MD.
They are requiring MD licensed only candidates to start the process.
The candidate must be comfortable in a cubicle environment, able to type and talk at the same time at a conversational pace and ability to navigate through multiple systems.
MUST have 5 TOTAL years of Post Masters Experience, with NO gaps in Employment.
Must be computer literate. Must be comfortable with Microsoft Office and know how to send and receive an e-mail, attach a document, accept meeting invites, work in Word, Excel (be able to sort and filter data). Not a lot in PowerPoint.
They need a Masters level behavioral health clinician with 5 years' post master experience that is licensed to practice independently.
MUST the license in Maryland, but they are also looking for candidates who hold a license in VA and/or DC in addition to the MD license.