Case Manager

About the role

The Case Manager develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder.

Responsibilities

• Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health, substance use and social determinant needs.
• Performs telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources.
• Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders.
• Collaborates with appropriate providers or specialists to ensure members have timely access to needed care or services.
• Maintains ongoing monitoring of care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs.
• Participates in Interdisciplinary team meetings as appropriate.
• Facilitates care coordination and collaborates with appropriate providers or specialists to ensure members have timely access to needed care or services.
• Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
• Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs.
• Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
• Meets operational and compliance with due dates for assessments, care plans, and all regulatory required activities.
• Upon notification of a crisis, the CM, and CM supervisor, as necessary, shall triage and employ necessary interventions to assist member recover from the crisis. If imminent danger is suspected or present activates emergency services, as necessary and consistent with training and policy.
• Performs tasks that align with and support departmental and organizational objectives.
• Maintains accurate written documentation and records of health coordination activities in case management systems according to appropriate service coordination and/or clinical guidelines.
• Safeguards confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality.
• Adheres to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality.
• Employees have access to AlohaCare data based on the data classification assigned to this job title.

Requirements

• Associate’s degree in behavioral health or social work or related field or equivalent combination of education and experience.
• Minimum 2 years of experience in related field.
• Experience with serving members in the community.
• Health plan experience with case management responsibilities.
• Experience with Medicare / Medicaid programs.
• Experience with individuals who have special health care needs, including HIV/AIDS, developmental disabilities, medically fragile, older adults, individuals with physical disabilities, housing insecurity, mental health and substance use disorder and other vulnerable needs.
• Previous experience in utilization management, discharge planning and/or housing resources.
• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization.
• Strong, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
• Ability to solve problems, analyze, think critically and make good judgment.
• Strong customer service skills and be able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
• Able to work independently with minimal supervision.
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
• Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated.
• Uses time effectively, reacts professionally under pressure.
• Working knowledge of Microsoft programs: Word, Excel, Outlook and PowerPoint.
• Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.
• Possession of valid driver’s license with access to a reliable insured automobile.
• TB Clearance.
• First Aid and CPR Certification.

Preferred Requirements

• Bi-lingual in any of the following languages preferred: Ilocano, Tagalog, Mandarin Chinese, Japanese or Korean.
• Ability to communicate using American Sign Language.
• Licensed RN with BH experience, LSW, LCSW, LMFT, LMHC, or LPC in the State of Hawaii.