Job Summary:

• Identify, track, and manage care for Behavioral Health high-risk patients.
• Conduct initial care coordination screening eligibility.
• Identify psychological, emotional and behavioral issues based on information obtained from initial intake.
• Provides ongoing clinical assessments, monitoring and follow-up for high-risk patients.
• Focus on using behavioral patient activation interventions, including motivational interviewing and self-management support.
• Assess psycho-social needs and provide community resources and referrals to outside agencies/programs when appropriate.
• Promotes clear communication amongst care team, including medical staff and BH staff regarding patient care plans.
• Participates in patient staffing and care conferences, and in the development and implementation of multi-disciplinary approaches to patient care.
• Contacts and develops community resources on behalf of patients and the Center, and acts as patient advocate as appropriate.
• Documents case management services through recording in the patient’s medical record and completion of reports and statistics.
• Handles protective health information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPPA).

Skills on Resume: 

• Clinical Assessment (Hard Skills)
• Care Coordination (Hard Skills)
• Behavioral Patient Activation Interventions (Hard Skills)
• Psycho-Social Assessment (Hard Skills)
• Interdisciplinary Collaboration (Soft Skills)
• Community Resource Development (Soft Skills)
• Advocacy (Soft Skills)
• Documentation and Compliance (Hard Skills)

Job Summary:

• Ensure the appropriate level of care management for high acuity patient population with mental health and substance abuse issues
• Work with patients during transitions of care from hospital to medical home 
• Ensures that receive appropriate and timely follow up at the clinic and externally
• Serve as the main contact for hospital staff at various facilities trying 
• Engage with the clinic for the purpose of discharge planning for patients dealing with behavioral health issues
• Meet with patients to conduct appropriate follow up after hospitalization and further links patients 
• Medical providers and care management staff to assist with accessing needed resources
• May conduct hospital visits to patients to assist in discharge planning and linkage to care
• Provide behavioral health clinical support for the care management team
• Represents Alivio Medical Center in professional and community organizations 

Skills on Resume: 

• Substance Abuse (Hard Skills)
• Care Coordination (Hard Skills)
• Interdisciplinary Communication (Soft Skills)
• Discharge Planning (Hard Skills)
• Patient Follow-up (Hard Skills)
• Referral Management (Hard Skills)
• Clinical Assessment  (Hard Skills)
• Representation (Soft Skills)

Job Summary:

• Acting as a liaison between the behavioral health department and providers/members to provide care coordination and Care management services.  
• Responsible for outreach activity with members and providers. 
• Document all activity in the member’s medical record in the electronic Care management documentation system. 
• Collaborate with the Clinical Care Managers and the Medical Care Management team in identifying, reviewing and assessing members’ need for behavioral health Care management. 
• Assist in providing Care management services for members 
• Screen and facilitate the review of outpatient treatment requests within contractual time frames.  
• Provide behavioral health Care management services to Prestige Health Choice Members.
• Conduct outreach calls and send outreach letters to Members.
• Assist Clinical Care Managers and Medical Care Managers in assessing members’ need for behavioral care management services.
• Collaborate with the medical Care management team, during scheduled meetings and informally 

Skills on Resume: 

• Communication Skills (Soft Skills)
• Care Coordination (Hard Skills)
• Documentation Skills (Hard Skills)
• Clinical Assessment (Hard Skills)
• Care Management (Hard Skills)
• Review and Evaluation (Hard Skills)
• Outreach and Engagement (Soft Skills)
• Team Collaboration (Soft Skills)

Job Summary:

• Complete Health Risk Assessments (HRAs) with members
• Develop care plans (short-term/long-term goals and tasks) and keep them updated.
• Outreach to coordinate with PCP and other community providers
• Identify problems/barriers for care coordination and appropriate Care management interventions to resolve.
• Identify barriers to member participation in treatment and solutions to resolve.
• Participate in ongoing education in regard to the practice of Care management or related skill areas.
• Process behavioral health appeals.
• Initial review of outpatient treatment requests for eligibility, duplication of services, completeness, and medical necessity.
• Disposition of outpatient treatment requests within contractual time frames.
• Facilitate Psychiatrist/Psychologist Advisor review of requests.
• Serve as a resource for internal case management and utilization review teams for member care management
• Utilize utilization management guidelines to ensure care plans meet medical necessity and cost-saving goals

Skills on Resume: 

• Health Assessment Skills (Hard Skills)
• Care Planning (Hard Skills)
• Communication (Soft Skills)
• Problem Identification (Hard Skills)
• Continuous Learning (Soft Skills)
• Behavioral Health Knowledge (Hard Skills)
• Utilization Review (Hard Skills)
• Team Collaboration (Soft Skills)

Job Summary:

• Works with patient/caregiver/co-learner to develop goals, informs care team if inappropriate for complex care and makes recommendation for care plan in usual care teams.
• Assists in the development of a comprehensive complex care management plan, with particular emphasis on socially or psychiatrically complex issues.
• Provides mental health support, linkage to ongoing mental health treatment, and 
• Direct care management including patient education, goal setting, self-management teaching, and coaching for the team’s high-risk patients.
• Interacts with patients and patient caregivers as appropriate to ensure continuity of care, patient adherence to care plans, and identification of barriers preventing adherence to care plan.
• Assess substance abuse and mental health needs and assess the patient’s readiness for change.
• Treat patients across the life span suffering with mental health concerns including anxiety, depression, mood disorders, etc.
• Conduct thorough psychosocial assessments and evaluate for appropriate DSM-5 Diagnosis
• Collaborate with Psychiatrist to develop and implement treatment plans
• Conduct initial evaluations (60 min) and follow up therapy sessions (30-60 min) to ensure comprehensive care of patients
• Performs general program administrative activities including report writing, bookkeeping and data collection

Skills on Resume: 

• Collaborative Goal Development (Soft Skills)
• Complex Care Management (Hard Skills)
• Mental Health Support (Hard Skills)
• Direct Care Management (Hard Skills)
• Continuity of Care (Soft Skills)
• Mental Health Assessment (Hard Skills)
• Psychosocial Assessment (Hard Skills)
• Treatment Planning (Soft Skills)

Job Summary:

• Participates in planning, implementing, coordinating, monitoring, and evaluating behavioral health treatment options and strategies for patients and families
• Meets with patients face to face in the clinic to conduct behavioral health screenings and explain available behavioral health services
• Maintains an active caseload and conducts multiple follow-up calls to monitor patient symptoms, provides patient education, and works on patient goals
• Assesses community support and resources for people in distress
• Provides crisis management and makes referrals to interventions as appropriate
• Completes thorough documentation in a timely manner
• Leads and attends meetings to accomplish community or integrated health care objectives
• May make school visits and other public presentations
• Assists in providing training for support personnel
• Performs literature reviews related to integrated healthcare
• Gathers and compiles a variety of educational materials and information
• Develops and uses printed materials effectively

Skills on Resume: 

• Clinical Assessment and Treatment Planning (Hard Skills)
• Communication Skills (Soft Skills)
• Case Management (Hard Skills)
• Community Resource Assessment (Hard Skills)
• Crisis Management and Referral (Hard Skills)
• Documentation and Record Keeping (Hard Skills)
• Leadership and Collaboration (Soft Skills)
• Education and Training (Hard Skills)

Job Summary:

• Provide telephonic support to members with behavioral health ad substance abuse disorder needs
• Perform initial assessments and develop care plans that address the patient-identified needs and evaluate the effectiveness of the plan by meeting goals
• Responsible for monitoring and evaluating the progress of the patient and working closely with the healthcare team to revise/adjust the care management plan to meet the needs of the patient
• Work from phone queue (call center) and receive inbound calls from members returning outreach calls
• Collaborate with internal and external teams to identify resources to meet the needs of patients
• Ensure care plans are cost effective and are appropriate in terms of quality of care
• Accurately record all patient information into EMR systems (Electronic Medical Record)
• Utilize clinical expertise to assess member needs related to complex psychiatric and substance abuse care at inpatient and outpatient clinical care levels
• Perform initial reviews and assessments of care to ensure proper care coordination, case planning, and monitoring to promote quality outcomes
• Provide members with educational, community, and provider referral resources based on individual member needs

Skills on Resume: 

• Communication Skills (Soft Skills)
• Assessment and Care Planning (Hard Skills)
• Case Management (Hard Skills)
• Customer Service (Soft Skills)
• Resource Coordination (Hard Skills)
• Cost-Effective Care (Hard Skills)
• EMR Documentation (Hard Skills)
• Clinical Expertise (Hard Skills)