Position Purpose: Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members’ current functional level and, in collaboration with the member, develop and monitor the Case Management Care Plan, monitor quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the Integrated Case Management functions. Collaborate with both medical and behavioral providers to ensure optimal care for members.
- Work telephonically with patients identified as high risk, for both behavioral and physical health issues, and their providers to identify needs, set goals and implement action steps towards achieving goals. Empower patients to help them improve their quality of life and ensure an integrated approach to address complex issues.
- Understand and comply with NCQA guidelines and HEDIS measures.
- Comply with established referral, pre-certification and authorization policies, procedures and processes by related Medical Management staff.
Education/Experience: Master’s degree in behavioral health and an unrestricted license as an LISW, LMHC, LMFT or RN required. 3+ years of case and/or utilization management experience. Experience in psychiatric and medical health care settings. Working knowledge of mental health community resources.
License/Certification: Unrestricted license as a LISW, LMHC, LMFT or RN required in the applicable state
Licensed Clinical Social Worker (Lcsw)
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Nurse Resolutions is a specialized recruiting and staffing firm with a focus of placing nurse, social work and other healthcare professionals into temporary, contract and permanent positions nationwide. The companies we partner with include hospitals, managed care organizations, insurance providers, medical management groups, third-party administrators, home health organizations, long term care facilities, pharmacies, outpatient clinics, healthcare consulting companies, medical supply organizations and many other types of companies. We recognize that a company’s success is strongly correlated with the talent that it attracts. Our firm utilizes a unique platform, combining proactive and passive recruiting methods with proven success to create value for client and candidate every time. Our recruiting strategies save time and effort while consistently ensuring highly-skilled professionals to the companies we partner with.
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