$15,000 sign-on bonus eligible position!
Provides inpatient and intensive outpatient case management for high-risk, high-utilizing members with acute and/or chronic psychiatric conditions across the continuum of care. Develops treatment and care plans for the specific population.
- Plans, develops, coordinates, assesses, and evaluates services provided to members to promote quality and cost effective outcomes.
- Develops and maintains case management policies and procedures to assure optimal and appropriate member utilization of services.
- Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals for outside services.
- Participates in the development of care paths.
- As an Intensive Case Manager coordinates the care of a large caseload of high risk patients and provides assessments and interventions in the community including in-home visits Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization.
- Arranges and monitors follow-up appointments.
- Makes referrals to appropriate community services.
- Identifies and recommends opportunities for cost savings and quality of care improvements across the continuum.
- Develops and collects reports and data, and trends utilization of health care resources.
- Develops and presents in-service training and communication to both internal and external stakeholders.
- Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
- Coordinates the transmission of clinical and benefit information and treatment to patients, families and outside agencies including issuing Non-Coverage and Denial of Benefits letters consistent with Health Plan Regulations.
- Acts as liaison to psychiatry clinics outside agencies, non-plan facilities, and outside providers.
- Coordinates repatriation of patients and monitors their quality of care. Provides administrative case management oversight to Inpatient Psychiatric Facilities, Crisis Residential Programs, and IMDs to ensure that services delivered to our members meet our Quality and Utilization expectations and guidelines.
- Provides administrative on-call to the RSR/Sub regional Office. Provides Clinical and Administrative documentation in accordance with our Regional Psychiatric Standards including the Inpatient/Integrated Urgent Services Guidelines.
- We conduct compensation reviews of positions on a routine basis. At any time, we reserve the right to re-evaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.