Resp & Qualifications
Provides care coordination to members with behavioral health conditions identified and assessed as requiring interventions and oversight including multiple clinical, social and community resources. This role promotes the appropriate use of clinical and other resources in order to improve the quality of care and member satisfaction.
Under the general supervision of a Director, FEP Case Management and with clinical oversight of a Director, Behavioral Health Clinical Oversight, the incumbent’s accountabilities may include, but are not limited to, the following:
• Manages a case load of 40 members
• Conducts clinical status review and completes the assessment outcome for all members on the FEP High Cost High Risk Roster.
• Provides outreach to all regional referrals for follow-up on mental health needs and collaborates with the care team to address members needs
• Conducts in depth health risk assessment and/or comprehensive needs assessment which
includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters
• Communicates and develops the plan of care and serves as a point of contact to ensure services are rendered appropriately (i.e. during transition to home care, back up plans,
community-based services upon discharge from a facility).
• Implements, coordinates, and monitors strategies for members and families to improve
health and quality of life outcomes. Develops, documents and implements a plan of care which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
• Assesses and reviews plan of care regularly to identify and address gaps in care, trends to improve health and quality of life outcomes; works with members to adjust plan of care, when necessary.
• Acts as an advocate for member’s care needs.
• Establishes a plan for weekly contact with the member.
• Performs ongoing monitoring of the plan of care to evaluate effectiveness and measures the effectiveness of interventions as identified in the members
• Provides telephone triage and emergency intervention as needed.
• Acts as resource to the member and the care team to provide information regarding mental health and substance use benefits, and community treatment resources.
• Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.
• Facilitates a team approach to ensure appropriate interventions, cost effective delivery of
quality care and services across the continuum.
• Provides information to members with questions and concerns regarding care, providers or delivery system.
• Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources
• Assists with orientation and mentoring new team members as appropriate.
• Other duties as assigned.
• Must be eligible for licensing in all three 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.
Must have CCM/ACM or other 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 in the next available testing cycle
• Effective application of best clinical practices.
• Solid understanding of behavioral health diagnoses.
• Must have proficient computer skills, including ability to converse and type at a
• Strong organization, time management and verbal and written communication skills.
• Knowledge of mental health and substance use
community resources and providers.
• Knowledge and experience in working with case management and in facilities, with local
care coordinators or with special populations.
• Knowledge of DSM V or most current diagnostic edition.
• Ability to analyze specific utilization problems, plan and implement solutions that directly
influence quality of care.
•Must demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
•Travel requirement: Must be able to provide own transportation to travel within assigned region to Provider offices and Panel meetings as directed.
Familiarity with web based software application environment. Previous experience working with or for a Patient Centered Medical Home.
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 10/13/2019
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship