JOB SUMMARY:
The BH Case Manager manages, creates and fosters comprehensive behavioral health and chemical dependency, utilization/case management through a series of activities that comply with all applicable regulations and statutes in adherence with the PBHC Compliance Framework.
- ROUTINE:
- Know and follow Employee Handbook policies and procedures.
- Have excellent written and verbal skills.
- Maintain patient/employee confidentiality.
- Actively contribute to all staff meetings.
- Follow dress code.
- Notify supervisor in writing when requesting time off.
- Be courteous and demonstrate customer service skills.
- Be flexible and adaptable to any situation or duty.
- Promote departmental and organizational goals.
- Know and follow applicable safety standards.
- ESSENTIAL JOB FUNCTIONS:
Work Position:
- Sitting - Frequency - 70% or more.
- Standing - Frequency - less than 25%.
- Walking - Frequency - less than 25%.
- Driving – Frequency – 25% or more
- Travel – Frequency – 10% or more
Body Movements:
- Lifting - 0-20 lbs; books, reams of paper, files, etc. - Frequency - approximately 20%.
- Bending, stooping and squatting - Frequency - approximately 15%.
- Reaching above head to 75 degrees - Frequency - approximately 15%.
- Hand/grip dexterity - Frequency - approximately 50%.
- SPECIFICS: (100% of time is dedicated to PBHC)
- Identifies patients meeting Chemical Dependency and/or Behavioral Health criteria to be placed in the Behavioral Health and/or Chemical Dependency case management program under the behavioral health management system through Utilization Review meetings, Primary Care Physicians/Provider notification, medical case management referral, risk stratification, medical records review, and data analysis.
- Complete triage assessments to determine appropriate program referral. Refer patients to appropriate providers and programs including but not limited to PHP/IOP.
- Utilization Management and/or collaboration of inpatient admissions
- Intensive case management of chemically dependent and SPMI (Seriously and Persistently Mentally Ill) population.
- Complete care authorizations as necessary
- Work with physician providers and ancillary personnel to establish the appropriate monitoring schedule needed for patients in the program.
- Management/monitoring of Behavioral Health/Chemical Dependency patients to include daily/weekly/monthly phone calls as per established criteria, post-hospital follow-up/discharge phone call and direct contact in clinics/hospital/skilled nursing facility/home.
- Communicate with the primary care physician and nursing staff to assure appointments are being kept and the overall treatment plan is being adhered to.
- Communicate with member, members’ family and caregivers to ensure appointments are being kept, medications are being filled and taken, and the overall treatment plan is being adhered to.
- Maintain a collaborative relation with the medical group and health plan staff to ensure patient education, referrals for appropriate trainings and other avenues/efforts to assist in patient compliance.
- Works as liaison between in-patient and outpatient delivery systems to ensure continuity of care.
- Maintain computerized tracking systems and databases.
- Generate various reports to constituents as appropriate.
- Compile statistics and generate various reports to constituents as requested
- Actively participate in Interdisciplinary Care Team meetings by presenting appropriate Chemical Dependency and Behavioral Health cases for discussion and contribute at meetings to promote total case management.
- Assist department supervisor/case managers as directed.
- Assist with reviews and updates on quality, utilization, and member management policies and procedures.
- Other duties as assigned.
The pay range for this position at commencement of employment is expected to be between $29.00/hour to $38.00/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.