Behavioral Health Case Manager

HealthPartners is hiring a Behavioral Health Case Manager. This position exists to provide support to patients, their families, and physicians in addressing behavioral health and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community.

ACCOUNTABILITIES

Member Focus

• Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient’s unique needs.
• Identifies interventions and resources to assist member reaching personal health related goals.
• Identifies patterns and episodes of care that are predictive of future needs and services.

Integration

• Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.
• Facilitates integration of patient care by encouragement of effective communications between patients, families, providers, health plan and care system programs, and community-based services.
• Adheres to policy and procedure in daily activities.
• Coordinates service coverage with appropriate funding sources when indicated.

Communication

• Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.
• Provides regular reporting of member outcomes to behavioral health leadership according to defined process.
• Identifies and promptly reports potentially adverse situations to department leadership.
• Identifies and promptly reports high cost cases for reinsurance.
• Maintains confidentiality of information in accordance with department and corporate policies.

Relationships and Team Building

• Establishes and maintains good working relationships within the Behavioral Health Improvement and Operations Department, with other HealthPartners Departments, and with other health team participants.
• Supports other team members in achieving patient centered goals.
• Assists supervisor in maintaining a cohesive team by contributing to a collaborative, respectful, and diverse environment.
• Participates in and contributes to appropriate departmental and/or organizational meetings.
• Acts as a liaison between internal customers, Marketing, Sales, Claims and Member Services to resolve systems/process issues.

Technology

• Maintains knowledge of and effectively uses automated applications and systems.
• Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor.
• Maintains maximum individual productivity through proficient use of automated systems.

Personal Development

• Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of case management, patient care services, and benefit packages for development of effective case management skills.
• Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.
• Maintains current, active Minnesota licensure.

Other Duties

• Willingly participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.
• Performs other duties as assigned.

REQUIRED QUALIFICATIONS

• Licensed in Minnesota as LICSW, RN or Psychologist, Masters degree preferred.
• Minimum of 3 years clinical practice experience; minimum of 3 years relevant utilization review, discharge planning, or case management experience; and current clinical knowledge.
• Demonstrated effective, clinical judgement and skills.
• Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication.
• Demonstrated working knowledge of QI, UM, benefit plans fiscal management, and various payment methodologies preferred. Understanding of healthcare and/or HMO industry.
• Demonstrated skill in effective use and management of automated medical management systems.
• Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.
• Ability to organize and prioritize multiple assignments within workload.
• Ability to deal with change and ambiguity.

DECISION-MAKING

• Makes independent decisions within the scope of this position’s accountabilities and determines the need for and the timing of consultation with behavioral health leadership.
• Uses sound judgement, organizational knowledge, industry knowledge, and common sense in determining appropriate alternatives for members/patients/families, consulting with leadership and/or Medical Director, when indicated.
• Utilizes the member contract coverage policy on-line benefits, level of care guidelines and Member or Claims Services on-line policies and procedures.
• Makes recommendations to leadership regarding policy development needs and/or changes.

MAJOR CHALLENGES

• Maintaining member focus in a rapidly evolving environment.
• Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the department.
• Maintaining timely, comprehensive reviews with concise documentation of pertinent facts, decisions and rationale.
• .Maintaining appropriate use of supervisory and consultation resources