New Directions Behavioral Health Hiring For Care Manager C365 at Overland Park, KS  Full Time

ROLE AND RESPONSIBILITIES

Schedule: Tuesday – Saturday 11:30am – 8:00pm CST

The Care Manager, C365 will be responsible for providing excellent clinical customer service by handling incoming telephone contacts from insured, EAP, uninsured callers, and providers. Depending on the nature of the call, the Care Manager conducts clinical telephonic focused screenings, provides referrals to appropriate health care and community resources, conducts clinical precertification for appropriate level of care, promotes care transitions activities for members being discharged from higher levels of care, addresses routine inquiries, and strives to reduce obstacles to access to behavior health care . This is a remote position.

ESSENTIAL FUNCTIONS

• Demonstrates a professional knowledge of mental health diagnosis and treatment modalities in a managed care and/or EAP context.
• Demonstrates knowledge of the range of mental health and EAP benefits provided by member’s insurance.
• Provides utilization review activities during established times for behavioral health care authorization requests with contacts to facilities and providers as needed to accomplish this task
• Demonstrates the ability to engage with members, families, providers; assess the callers needs; and provide education, resources, and navigation to promote access to behavior health services.
• Promotes and provides effective and quality service delivery for optimal member health outcomes
• Coordinates and/or completes peer review process on clinical cases that are not meeting the medical necessity criteria
• Provides clinical expertise in response to a variety of circumstances ranging from crisis intervention to routine business matters
• Utilizes appropriate and standardized tools including but not limited to NDBH approved precertification, physician review tools, authorization screen, and other application and tools
• Completes appropriate documentation in clinical systems in compliance with regulatory and accreditation standards
• Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and New Directions services, policies and procedures and criteria
• Coordinates consultations with member’s provider, family and NDBH Physician consultants on clinical cases when necessary and appropriate to facilitate care and progress
• Stays current with New Directions’ technology, member Behavioral Health benefits, and non-health community resources
• Provides follow-up and support calls to members and providers as needed and as assigned by Manager/Supervisor
• Works during holidays as scheduled unless paid time off arrangements are made with manager.
• Demonstrates the initiative, self-organizational skills, self-discipline, and competence to work remotely from a home office.
• Has a home based office that provides an environment conducive to completing assigned job responsibilities and meets the standards outlined under the New Directions telecommuting policy
• Is flexible and willing to provide assistance to co-workers when needed in urgent or routine situation Covers assigned hours/shifts and has the ability to cover other shifts as assigned by department director, manager, or designee and serves on the department clinical on-call rotation as mandatory
• Participates in on-going continuing education as required by professional licensure, certification, or as requested by New Directions and maintains required clinical licensure and certifications
• Participates in special committees or projects for program development as assigned by the Manager/Supervisor
• Attends on site staff meetings, required professional trainings, New Directions all staff meetings, after-hours staff meetings
• Participates in group peer process in which difficult cases are presented where interventions are validated as appropriate as well as suggestions for change and problem solving occurs
• Adheres to the policies and procedures for Utilization Management activities as well as screening, triage and referral activities, including timeliness of activities/services and accuracy of documentation
• Adheres to Professional Codes of Ethics as determined by professional licensure, certification and company policy
• Adheres to New Directions Behavioral Health Mission Statement, Core Values, Code of Business Conduct and Compliance Program
• Complies with all Federal and applicable State laws and New Directions Behavioral Health policies regarding privacy, confidentiality and security of health information and other designated information

This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities as deemed necessary.

MARGINAL (NON-ESSENTIAL) FUNCTIONS

• None

JOB QUALIFICATIONS:

EDUCATION & EXPERIENCE

REQUIRED

• A current, unrestricted license issued by a state or territory of the United States as a Clinical Social Worker, Marriage and Family Therapist, Professional Counselor, Clinical Psychologist or Registered Nurse.
• Minimum of 3-5 years of direct clinical care experience with patients in facility-based and/or outpatient psychiatric or chemical dependency treatment
• Strong clinical skills
• Excellent verbal and written communication and interpersonal skills
• Strong computer and keyboarding skills (Microsoft Outlook and Word), including the ability to document while simultaneously while taking information over the phone

PREFERRED

• Minimum of five (5) years post-licensure experience in direct clinical care with patients in facility-based and/or outpatient psychiatric or chemical dependence treatment
• For Registered Nurses, a Bachelor’s Degree in Nursing
• Previous EAP experience, CEAP certification
• Minimum of two (2) years’ experience in a managed care environment.
• Minimum of two (2) years’ experience in crisis intervention work, in-service and professional training experience
• Previous experience in Utilization Review
• Experience and training in Motivational Interviewing

KEY ATTRIBUTES

• Self-motivated and the ability to assume a role in ensuring that all objectives are met
• Ability to work independently to complete work assignments and team objectives/goals
• Maintains curiosity and an eagerness to explore new knowledge and try new ideas and approaches
• Excellent communication and interpersonal skills
• Professional demeanor in response to all situations regardless of the nature or circumstances of the situation
• Able to manage multiple tasks in a fast-paced, changing environment
• Ability to work within a collaborative, team-oriented environment
• Ability to work efficiently and effectively in a remote environment with other remote team members and a remote supervisor

PHYSICAL/MENTAL DEMANDS

• Physical
  • Constant:
    • must be able to remain in a stationary position
    • must be able to move about inside the office
    • must be able to communicate and exchange information with others
    • must be able to inspect information
    • must be able to perform repetitive motion with arms and fingers
• Mental
  • Constant
    • must be able to interpret data
    • must be able to problem solve
    • must be able to make decisions
    • must be able to organize and plan

WORKING CONDITIONS/EQUIPMENT USE

• Work is performed indoors in a typical office environment- not substantially exposed to adverse environmental conditions
• Frequent exposure to VDT screen
• Frequent use of office machines to include telephone, copier, computer and fax machine

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