| Location | Remote-OH, OH (Remote) |
Job Profile Summary: Position Purpose: 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. Education/Experience: Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2 4 years of related experience. License/Certification: Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required For Illinois Youth Care plan only: Graduate degree and independently licensed behavioral health clinician (e.g. LCSW, LCPC, PsyD) in Illinois or Bachelor s Degree and IL RN licensure. Must reside in IL required For NJ Health Plan Only: Requires a Master's degree in Behavioral Health or Social Work and a Licensed Associate Counselor (LAC) or Licensed Social Worker (LSW) required For Sunshine Health (FL) Only: Employees supporting Florida's Children s Medical Services must Hold a Master s degree in social work or related field and have one year of related professional pediatric care experience. May require up to 80% local travel required 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 and social determinant needs May perform 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 Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members Monitors 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 Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has 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 Performs other duties as assigned. Complies with all policies and standards. | ||||||
| Story Behind the Need | ||||||
| Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families Everyone works together to ensure our members get the care and services they need to remain as independent as possible | |||||
| Typical Day in the Role | ||||||
| Log on laptop top by 8am, review emails, tasks, and voicemails and respond to any urgent needs. Review calendar for possible meetings and/or scheduled visits. Staff typically arrange their days with the expectation of 5-7 visits required weekly. Documentation must be completed within 24 hours. Performance expectations: 5-7 visits weekly, ensuring documentation is completed within 24 hours. Meeting required turn-round times for processes, and completing trainings timely. Working with amazing coworkers and leadership, while also caring for those individuals in need. Staff at Buckeye have worked here for years, there isn t a high turnover rate. | |||||
| Candidate Requirements | ||||||
| Education/Certification | Required: Required: Bachelor s degree in counseling or social work and 2 4 years of related experience | Preferred: 2-4 years of related experience with Behavioral Health | ||||
| Licensure | Required: LPC, LPCC, LSW | Preferred: | ||||
| Years of experience required: 2-4 years of experience nursing, case management, home health, behavioral health. reliable vehicle for weekly travel Disqualifiers: Inability to work independently, manage change well, position longevity (state if contract role), Additional qualities to look for: Someone who works well independently, personable, strong communication skills. Someone who can think critically, be flexible, open to change, and can also work well on a team. | ||||||
| 1 | Computer Literate IS A MUST (knowledge of Microsoft) Excel, Word, Team, Outlook, One note, One Drive, PowerPoint, Explorer, Chrome. | ||||
| 2 | Critical Thinker | |||||
| 3 | Works well independently, troubleshooting | |||||
| Candidate Review & Selection | ||||||
| Projected Manager Candidate Review Date: | 1-2 days post shortlisting | ||||
Type of Interviews: | Teams, Cameras On | |||||
| Required Testing or Assessment (by Vendor): | Agencies must perform computer literacy test - Excel, Word, Team, Outlook, One note, One Drive, PowerPoint, Explorer, Chrome test, basic computers skills test, etc. | |||||
| Next Steps | ||||||
| No | |||||
| n/a | |||||