Licensed Behavioral Health Clinician

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Care Manager, BH provides care management services at facilities, in the community and telephonically for WellSense members receiving behavioral health (BH) and substance use services. The Care Manager, BH works alongside medical Utilization Management and medical Care Management staff, pharmacists, and medical directors as part of an integrated team and follows members through the health care continuum, including acting as the liaison for hospital staff, PCPs, and other healthcare team members in facility discharge planning.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

• Performs a variety of diverse and complex telephonic and face-to-face care management responsibilities and ensures that all service needs are met through monitoring of treatment plans, crisis plans, and interagency collaboration.

• Supports member transitions from inpatient to post-acute or community settings via engagement with facilities and other transitional team members while the member is still on the unit; this effort may include the need to engage with the facility staff and the member in a face-to-face setting as appropriate.

• Secures follow up appoints for the member as appropriate, to include connections with the member and providers post-discharge to ensure compliance with aftercare appointments.

• Educates member to ensure a level of awareness around symptom, effective monitoring, and identification for the need of additional supports.

• Manage and carry out all activities of the Care Management Programs. This includes accepting referrals, identifying appropriate care management candidates, ensuring that all their service needs are met, and tracking their progress.

• Completes Comprehensive Assessments at BH, SUD, and/or medical facilities and in the community (as needed and directed by the Manager or Supervisor) for members identified as part of the priority population and members in transition of care in a timely manner.

• Conducts BH/SUD screenings for complex and non-complex cases as needed.

• Develops an Individual Care Plan (ICP) per Care Management policy and collaborates with the members' providers to discuss ongoing care, offer potential solutions to clinical and/or social barriers and obstacles, and serves as a facilitator for future needs of the member.

• Implements treatment plans to assist members to develop the skills needed to successfully live and work as independently in the community as they are able.

• Utilizes technique such as Motivational Interviewing, Harm Reduction, Trauma Informed Care principles, Stages of Change and evidence-based practices to move the member towards readiness to engage in services, medication compliance, etc.

• As needed identifies service delivery gaps and barriers, ensures appropriate evaluation, service planning, and service delivery, and monitors care plan implementation and progress.

• Outreaches to members for medication monitoring and to encourage them to comply with medication regimens. Educates members as needed regarding the role and use of medications in their recovery.

• Works closely with families as appropriate and includes members and their families in service planning.

• Works closely with state agency case management staff, particularly the Department of Mental Health.

• Attends to and takes part in round meetings presenting cases and/or providing recommendations and support to other care managers.

• In all activities works to ensure linkage and integration of behavioral health and medical care. This includes both member-based activities and work with agencies as part of community-based care management.

• Documents clinical assessments and coordination of care in the medical management information system in a timely manner that meets regulatory and accreditation standards.

• Facilitates all regulatory/accreditation correspondence.

• Meets departmental productivity and quality standards; maintains designated caseload volume and adheres to turn around times standards.

• Provides high level of service and satisfaction to internal and external customers

• After-hours availability as needed

• Regular and reliable attendance is an essential function of the position.

• Promotes best practices and engages in activities to ensure reduction of member readmissions, harm avoidance, health and quality of life improvement

• Performs other duties as assigned.

Supervision Exercised:

• No direct supervision exercised

Supervision Received:

• General supervision is received weekly.

Qualifications:

Education:

• A master's or doctoral degree in a behavioral health field such as psychology, clinical counseling, or social work

Experience:

• Two or more years related experience in Mental Health, BH Case Management, and/or substance abuse treatment

Experience Preferred/Desirable:

• Experience with Medicaid recipients and community services.

• Experience with care management.

• Experience in a health plan or insurance environment

• Previous geriatric psychiatric experience or other related experience with a geriatric population in an integrated medical/behavioral health model strongly preferred

Certification or Conditions of Employment:

• Must hold a current certificate or state licensure