Job Description

SHIFT: Monday-Friday 8:00 am-5:00 pm

Description:

• Fully Remote. Telephonic Work. No field work needed for this role.
• Must have an LPC or LMSW - Unrestricted and Active in State of Michigan
• The Case Manager utilizes a collaborative process of Assessment, Planning, Facilitation and Advocacy for options and services to meet an Individual's Benefit Plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
• Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred members' needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal and external programs/services
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Duties:

• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators that impact care planning and resolution of member issues.
• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
• Provides crisis follow-up to members to help ensure they are receiving the appropriate Treatment/Services.
• Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or members’ needs to ensure appropriate administration of benefits
• Using a holistic approach, consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain a multidisciplinary view in order to achieve optimal outcomes
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve the optimum level of health

Required Qualification:

• 3+ years of Direct Clinical Experience
• Case Management experience preferred
• Must have an LPC or LMSW - Unrestricted and Active in State of Michigan
• Case Management Certification CCM preferred.
• Effective communication skills, both verbal and written.

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