Care Manager

Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes.

ESSENTIAL FUNCTIONS

Weight Essential Functions

50% Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with member, family and providers to develop a comprehensive plan of care to address the member's needs at various stages along the care continuum. Identifies relevant Client and community resources and facilitates program, network, and community referrals.

50% Collaborates with member and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member's medical, behavioral and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies to facilitate care between settings. Monitors, evaluates, and updates plan of care over time focused on member's stabilization and ability to self manage. Ensures member data is documented according to Client application protocol and regulatory standards.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: High School Diploma or GED

Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience. See additional information below if Care Manager position is behavioral health focused.

Preferred Qualifications

Bachelors degree in nursing

CCM/ACM or other RN Board Certified certification in case management. Federal Employee Program (FEP) Book of Business (ONLY): Must have CCM/ACM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM or ACM exam and successfully achieve the certification within the first year of employment.

Knowledge, Skills and Abilities (KSAs) Proficiency

Knowledge of clinical standards of care and disease processes. Advanced

Ability to produce accurate and comprehensive work products with minimal direction. Advanced

Ability to triage immediate member health and safety risks. Advanced

Basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits). Proficient

Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members. Advanced

Knowledgeable of available community resources and programs. Proficient

Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint Proficient

Ability to provide excellent internal and external customer service Advanced

Additional Skills and Abilities

For Behavioral Health Care Managers, must have the following Education, Experience and License(s):

Must be licensed in at least one of the three states and/or jurisdictions shown below and have the ability to meet credentialing requirements for independent professional practice (Masters

level licensed behavioral health professional):

-Maryland: LCSW-C or LCMFT or LCPC

-Washington, DC: LICSW or LPC or LMFT

-Virginia: LCSW or LPC or LMFT

Master's degree in Mental Health field required; education can be in one or more of the following areas: Social Work, Psychology, Nursing or Counseling.

Minimum 5 years post masters clinical behavioral health/psychiatric experience required.

Effective application of best clinical practices.

Solid understanding of behavioral health diagnoses.

Knowledge of mental health and substance use

community resources and providers.

Knowledge of DSM V or most current diagnostic edition.