Job Summary:

• Responsible for assessing current behavioral health status for members
• Identifies and provides community service linkage
• Assists enrollees with aftercare appointments
• Provides subsequent member follow-up as determined by individual member needs
• Works with enrollees to identify gaps in care or obstacles to care and problem-solves for successful connection to needed services
• Reviews IP Census each day to determine which enrollees on the census are re-admits within the last 12 months
• Attends meetings with the treatment team to develop a successful aftercare plan
• Manages the aftercare follow-up of identified high-risk enrollees (manages follow-up calls/outreach and documentation)
• Meets with community providers/facilities as company liaison to foster good rapport and relationships and to identify new programs
• Provide telephonic case management services to members which include coordination of care and behavioral health consulting

Skills on Resume: 

• Evaluation Skills (Hard Skills)
• Communication Skills (Soft Skills)
• Case Management Expertise (Hard Skills)
• Problem-solving Skills (Soft Skills)
• Relationship Building (Soft Skills)
• Interpersonal Skills (Soft Skills)
• Documentation Skills (Hard Skills)
• Remote Service Skills (Hard Skills)

Job Summary:

• Providing behavioral health education, coaching and treatment decision support for members
• Assess and interpret customer needs and requirements
• Identifies solutions to non-standard requests and problems
• Assessing the current behavioral health status for members
• Identify and prioritize gaps in care to develop plan of care to empower members to meet identified goals
• Review treatment plans and coordinate transitions between various areas of care
• Obtain information from providers and coordinate services amongst provider group
• Provide case management to members to assess for and find solutions to obstacles to care
• Link members to healthcare providers and community supports
• Work with members via telephone and face-to-face contacts to address healthcare needs

Skills on Resume: 

• Behavioral Health Knowledge (Hard Skills)
• Needs Assessment (Hard Skills)
• Problem Solving (Soft Skills)
• Care Coordination (Hard Skills)
• Case Management (Hard Skills)
• Goal Setting and Planning (Hard Skills)
• Interpersonal Skills (Soft Skills)
•  Community Outreach (Soft Skills)

Job Summary:

• Provide field visits to members who have been admitted to behavioral health hospitals
• Meet with members in the hospital and home
• Assist inpatient behavioral treatment team with discharge planning
• Collaborate treatment plans with outpatient providers
• Assist the member with transitioning back into the community following an out-of-home placement
• Work with members to assist with getting medications filled, making follow-up appointments and arranging transportation to medical appointments
• Explain behavioral health insurance benefits and what behavioral health services are available
• Focus on initial inpatient admission for psychiatric and chemical dependency patients
• Make patient assessments and determine appropriate levels of care (could include inpatient, residential, and partial levels of care)
• Obtain information from providers on outpatient requests for treatment

Skills on Resume: 

• Behavioral Health (Hard Skills)
• Case Management Abilities (Hard Skills)
• Communication Skills (Soft Skills)
• Organizational Skills (Soft Skills)
• Decision-Making Skills (Hard Skills)
• Knowledge of Healthcare Systems (Hard Skills)
• Supportive Skills (Soft Skills)
• Crisis Management (Soft Skills)

Job Summary:

• Determine if additional clinical treatment sessions
• Manage inpatient and outpatient mental health cases throughout the entire treatment plan
• Coordinate benefits and transitions between various areas of care
• Identify ways to add value to treatment plans and consult with facility staff or outpatient care providers on those ideas
• Support other sub-teams within Utilization Management with authorizations for treatment at Residential Substance Use programs and Long Term Care facilities
• Making patient assessments and determining appropriate levels of care
• Obtaining information from providers on psychiatric requests for treatment
• Determining if additional clinical treatment meets medical necessity
• Managing inpatient, outpatient, and crisis residential mental health cases throughout the entire treatment plan
• Administering benefits and reviewing treatment plans
• Coordinating benefits and transitions between various levels of care
• Identifying ways to add value to treatment plans and consulting with facility staff or outpatient care providers on those ideas

Skills on Resume: 

• Clinical Knowledge (Hard Skills)
• Case Management (Hard Skills)
• Utilization Management (Hard Skills)
• Interpersonal Communication (Soft Skills)
• Strategic Planning (Hard Skills)
• Benefits Coordination (Hard Skills)
• Decision-Making (Soft Skills)
• Documentation and Compliance (Hard Skills)