Description
About the Job
Job Summary:
MedStar Health is looking for a Clinical Behavioral Health Case Manager to join our team at MedStar Family Choice! We are looking for someone who can use a computer to enter and retrieve data and can create, edit, and analyze Microsoft office (Word, Excel, and PowerPoint) preferred.
The Clinical Behavioral Health Case Manager will coordinate, negotiate, procure and manage care of our Enrollees to facilitate cost effective care and Enrollees satisfaction. Facilitates the continuum of care, works collaboratively with interdisciplinary staff, internal and external to the organization. Support our Enrollees, medical and psychiatric providers/consultants, and the Care Management teams in the integrated delivery of care across the mental health, substance use and physical healthcare continuum.
Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the "Healthiest Maryland Businesses". Apply today and learn how MedStar Health can be your next great career move!
Primary Duties:
Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care. Acts as an advocate while assisting Enrollees to coordinate and gain access to medical, psychiatric, psychosocial, social determinant of health (SDOH) needs, and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
Maintains working knowledge and collaborative relationships with District of Columbia agencies and resources. Attends and participates in MedStar Family Choice staff meetings, Clinical Operations department meetings, Special Needs Forums, work groups, District/ community agencies meetings, etc., as assigned. Provides input, completes assignments, and shares new findings with other staff. Attends court ordered hearings and helps with coordinating needed care.
Demonstrates skill and flexibility in providing coverage for other staff. Identifies and reports potential coordination of benefits, subrogation, third party liability, worker's compensation cases, etc. Identifies quality, risk, or utilization issues to appropriate MedStar Health personnel. Initiates contact with providers to obtain clinical information to facilitate approval or pending of pre-certification requests, as appropriate. Interfaces with the community for home visits or group meetings.
Maintains knowledge of MedStar Family Choice benefits and enrollment issues to accurately coordinate services. Maintains timely and accurate documentation in the clinical software system per Clinical Operations department's policies. Provides ACD (Automatic Call Distribution) telephone coverage and processes calls related to PCP (Primary Care Physicians) and provider questions, eligibility and benefits, transportation, and authorization issues.
Works to actively develop and/or manage assigned case management programs, such as HIV (Human Immunodeficiency Virus), substance use disorders, and behavioral health conditions as appropriate for the population served. Keeps informed about disease processes, treatment modalities, and resources. Supports the mental and physical health care of Enrollees on an assigned caseload. Closely coordinating care with the Enrollee's caregiver, medical provider, and other mental health providers. Assisting hospital case management staff with discharge planning, as applicable. Facilitates referrals for clinically indicated services outside of the organization (e.g., social services such as housing assistance, vocational rehabilitation, mental health specialty care, substance use treatment).
Qualifications:
Master's degree in social work or master's degree in clinical Mental Health/Counseling or similar.
1-2 years 2 years recent care/case management experience.
3-4 years diverse clinical experience and behavioral health per population served.
Valid Social Worker in the District of Columbia Upon Hire Required or LPC-Licensed Professional Counselor in the District of Columbia.
Licensed Independent Clinical Social Worker (LICSW) or Licensed Professional Consultant (LPC) preferred.
This position has a hiring range of
USD $61,838.00 - USD $111,259.00 /Yr.
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