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- La Grande, OR 97850
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KEPRO • La Grande, OR
Posted 2 months ago
KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. KEPRO is seeking resumes for a highly experienced professional
QMHP Case Manager
The Qualified Mental Health Provider in this position will be conducting face to face interviews with severely mentally ill people to create a Person-Centered Service Plan, provide information about eligibility and referrals, resources, services and supports covered under the 1915i State Plan Home and Community Bases Services benefit. Additionally, there will be Behavioral Health Utilization Management done by reviewing necessary clinical information, conducting the Level of Care Utilization System (LOCUS) and the Level of Service Inventory (LSI) as well as conducting eligibility redeterminations at least every 12 months. The position also supports Oregon Health Authority as they manage the appeals of determination process.
- Conducting face to face interviews with severely mentally ill people to create a Person-Centered Service Plan
- Provide information about eligibility and referrals, resources, services and supports covered under the 1915i State Plan Home and Community Bases Services benefit.
- Conduct Behavioral Health Utilization Management by reviewing necessary clinical information, conducting face to face needs assessments
- Complete the Level of Care Utilization System (LOCUS) and the Level of Service Inventory (LSI) that will assign functional assessments to members
- Conducting eligibility redeterminations at least every 12 months for assigned cases.
- Represent and promote KEPRO while doing assessments in the community with members and providers while supporting Oregon Health Authority mission.
- Remain abreast of contract requirements and state, and regulatory changes regarding case management duties.
- Assure compliance with regulatory, criteria and any accreditation requirements.
- Participate in activities specific to contractual arrangements e.g. appeals and hearings
- Participate in KEPRO’s Quality Management Team as needed to ensure organizational compliance.
- Attend Interdisciplinary team meetings, providing input regarding difficult cases and processed in discussions and problems solving.
- Work with other clinical and administrative staff to identify matters needing shared attention. Discuss, inform, and facilitate communication and interaction between providers, staff and members.
- Master’s degree in Health and/or Human Service field. QMHP. License must be in same state as contractually required.
Skills, Knowledge Abilities
- Knowledge of NCQA/URAC standards strongly preferred.
- Knowledge of the organization of medical records, medical terminology, and disease process required.
- Strong clinical/social assessment and critical thinking skills required.
- Excellent verbal and written communication skills required.
- Ability to use independent judgment and discretion to address, resolve and process problems impeding the service needs.
- Proactively identify and resolves delays and obstacles.
- Ability to work in a team environment.
- Flexibility and strong organizational skills needed.
- Must be proficient in MS Office, Internet/Web Navigation
- Must have high-speed (no dial-up) internet at home.
- Must be willing to travel and have active, unrestricted license, reliable transportation and active auto insurance.
- Must have an OSHA compliant home workspace and committed to confidentiality of PHI.
- Working knowledge of Federal, State and private health related activities.
- Must have demonstrated experience working with severely and mentally ill population
- Must be comfortable working with electronic medical system
Mental and Physical Requirements
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.
KEPRO offers challenging careers, excellent benefits and opportunities for advancement. For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please. Visit our website at www.KEPRO.com for more information on the KEPRO Family of Companies.
EOE AA M/F/Vet/Disability
KEPRO is an E-Verify employer. E-Verify is an internet based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA) that allows participating employers to electronically verify the employment eligibility of their newly hired employees in the United States.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.