Behavioral Health Care Manager(Case Manager)Wellcare - Chicago, IL
Behavioral Health Care Manager(Case Manager)','1705073','!*!About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at www.wellcare.com or view our videos at https://www.youtube.com/user/WellCareHealthPlan.EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.','!*!Conducts comprehensive member psychosocial assessments through root cause analysis and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs. Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Assess members to recommend activities and behavioral routines to meet the social and medical needs of members and their families. Provides support and/or intervention and assists members in understanding the implications and complexities of their current medical situation and/or overall personal care.
DEPARTMENT: Health Services
REPORTS TO: Sr. Director, Field Health Services/Field Case Management
Assesses, plans, implements, monitors and evaluates options and services to meet complex psychosocial health needs of inpatient and outpatient members. Manages a caseload in compliance with contractual obligations and WellCare standards.
Conducts comprehensive member assessments through root cause analysis based on referred member's needs and benefit plan eligibility, and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs.
Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Works towards achievement of optimal clinical and resource outcomes.
Monitors and evaluates effectiveness of care plan and modifies plan as needed. Supports member access to appropriate quality and cost effective care. Coordinates with internal and external resources to meet identified needs of the member's care plan and collaborates with providers.
Acts as a liaison and member advocate between the member/family, physician and facilities/agencies. Provides clinical consultation to physicians, professional staff and other teams members/supervisors to provide optimal quality patient care and effective operations.
Interacts continuously with members, family, physician(s), and other resources to determine appropriate behavioral action needed to address medical needs. Reviews benefits options, researches community resources, trains/creates behavioral routines and enables members to be active participants in their own healthcare.
Ensures members are engaging with their PCP to complete their care management treatment plan or preventive care services.
Assists in obtaining benefits for members through community resources when benefits are exhausted or not available.
Performs other duties as assigned.
Will travel locally
Required a Master's Degree in Social Work, Psychology, Counseling, Rehabilitation, or other relevant field that provides a foundation to receive a license as required of the position Candidate Experience:
Required 2 years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning
Required 1 year of experience in current case management as a licensed professional
Required experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Preferred experience in a managed care environment Candidate Skills:
Intermediate ability to work independently Ability to work independently, handle multiple assignments and prioritize workload
Intermediate ability to multi-task
Intermediate demonstrated time management and priority setting skills
Intermediate demonstrated interpersonal/verbal communication skills; communicates effectively in person and by phone
Advanced ability to create, review and interpret treatment plans Ability to create, review and interpret treatment plans
Intermediate ability to effectively present information and respond to questions from families, members, and providers
Intermediate knowledge of healthcare delivery
Intermediate knowledge of community, state and federal laws and resources
Intermediate demonstrated written communication skills
Intermediate demonstrated customer service skills
Intermediate ability to effectively present information and respond to questions from peers and management
Intermediate demonstrated problem solving skills Licenses and Certifications:A license in one of the following is required:
Required a master's level independent or non-independent license is required OR an RN with a behavioral health background:
Required Licensed Registered Nurse (RN)
Required Licensed Clinical Social Worker (LCSW) LSW, LCSW, LMHC, LPC, LMFT, PsyD
Required Licensed Clinical Mental Health Counselor (LCMHC)
Required Licensed Clinical Professional Counselor (LCPC)
Required Licensed Clinical Marriage & Family Therapist (LCMFT)
Required Licensed Clinical Psychologist (LCP)
Required Licensed Master Social Work (LMSW)
Required Certified Social Worker (C-SW)
Required Acute Care Nurse Practitioner (APRN) (ACNP-BC)
Required intermediate Microsoft Outlook, Word and Excel
Required intermediate Microsoft Word Knowledge of or the ability to learn company approved software such as EMMA, CRMS, Peradigm, InterQual, Sidewinder and other software in order to perform job duties
Required Intermediate Healthcare Management Systems (Generic)
Bilingual helpful ','US-IL-Chicago','29 North Wacker Dr','Suite 300','Chicago','60606','','Yes, 75 % of the Time','No','No','Behavioral Health Care Manager(Case Manager)'
15 days 3 hours ago
applyBehavioral Health Care Manager(Case Manager) Wellcare - Chicago, IL, United States
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.
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