Behavioral Health Caseworker

AmeriHealth Caritas · Columbia, SC · 1 wk ago

RemoteRemoteOTHRFull-time

Role Overview

Responsible for managing and coordinating care, services, and social determinants of health for Members with behavioral health conditions and acute, chronic, and medically complex needs. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care, and barriers to care.

Responsibilities

Develops a plan of care through shared decision-making with the Member/caregiver and in collaboration with providers and other care team members to improve the Member's health status and compliance with treatment plans and promote self-management.
Supports Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the plan's effectiveness.
Reviews the medication list and helps members coordinate pharmacy needs with a community pharmacist to ensure medication reconciliation is completed when any changes occur.
Evaluates, monitors, and updates the care plan through regularly scheduled follow-up contacts based on the Member/caregiver's progress, needs, and preferences.
Establishes points of contact in order to collaborate with identified community, medical, and/or behavioral health teams.
Maintains timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable.
Monitors appropriate utilization and coordinates services with other payer sources, makes appropriate referrals, and identifies and escalates quality of care issues.
Develops a working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements.
May identify cases to be presented at care management rounds and follow up with providers on recommendations to achieve optimal outcomes for Members.
Supports a positive workplace environment, collaborates, and shares clinical knowledge and skills to support our culturally and demographically diverse Member population.
Conducts Face-to-face visits at the Member's residence, provider's office, hospitals, other acute locations, or community locations for education and/or assessment.

Work Arrangement

Remote; Field-Based. Regular travel required throughout assigned South Carolina service area and surrounding regions. Candidates residing in or near Upstate (Spartanburg County), Midlands (Columbia area), Low Country (Charleston County), and PeeDee (Lee County, Dillon County) are strongly preferred. Must have valid driver's license, reliable transportation and auto insurance.

Education & Experience

Required Bachelor's Degree in related field (i.e., social work, health science, psychology, sociology, early childhood education, etc.). Masters prepared will be given preferred consideration.
2 years of proven professional experience working directly with SMI members (Serious Mental illnesses) aged six and up who may have one of the following conditions: Psychotic Disorders, Bipolar Disorders, Major Depression.
2 years of social services experience, engaging with clients (e.g., individuals, families, communities), routinely assessing their needs, connecting them to services, and monitoring their progress.
Proficiency using MS Office (Word, Excel, Outlook), internet applications, and electronic medical record and documentation programs.
Electronic Case Management Platform (i.e. Jiva).
Strong documentation and record-keeping skills are required, emphasizing accuracy and adherence to established methods.
Proven professional expertise in assessing members' situations, developing care plans, and teaching self-management.
Skilled in working one-on-one with members, effectively communicating preventative health and management philosophies, and presenting health education materials to both individuals and small groups.

Benefits