Primary Purpose:

Performs telephonic case management for patients receiving services in all levels of behavioral health care. Is a member of an interdisciplinary care management team, responsible for providing and coordinating brief telephonic care coordination for a select panel of patients identified to have a behavioral health issue.

Major Responsibilities:

Assesses and reviews cases for medical necessity based on established behavior health criteria. Assesses and determines best course of care and makes recommendations for appropriate level of care.

Monitors and coordinates the care plan through concurrent review as needed with other members of the Care Management Team, retrospective chart review and prospective review of patient's treatment plan. Maintains and updates accurate clinical and patient records according to agency, State and Federal guidelines.

Facilitates appropriate and prompt access to physician specialists, and coordinates patient information and communication between the referring/accepting facilities and physicians as well as patient referrals to specialized services ensuring smooth transitions of care.

Provides supportive telephonic counseling to patients as needed. Provides care to patients with multi-diagnoses in medical and psychiatric conditions through scheduled telephone assessment and follow up. Effectively uses patient engagement strategies to reach and enroll patients, assist patients in self-actualization in their healthcare needs.

Supports patients by providing education, addressing needs, advocating, providing continuity of care, ensuring patient satisfaction and identifying potential barriers to learning and/or to the delivery of care.

Participates in clinical and administrative meetings to promote quality, cost-effective treatment outcomes as needed.

Using effective and service-oriented presentation style, develops and maintains collaborative working relationships with providers and others involved in the delivery of care to patients.

Provides clinical backup for other Care Coordinators requesting a review of a case with potential behavioral health issues. Provides on-going team member training on relevant Behavioral Health topics.

Reviews all high-risk cases, complaints, and grievances with direct supervisor as necessary.

Coordinates and implements case management referrals by communicating directly with physicians, families, vendors, third party administrators (TPA's), medical directors, Utilization Management staff, hospital staff and other appropriate ancillary providers on a regular basis.

Licensure, Registration and/or Certification Required:

Marriage and Family Therapist license issued by the state of Wisconsin, or

Registered Nurse license issued by the state in which the team member practices, or

Social Worker, Clinical license issued by the state of Wisconsin, or

Professional Counselor license issued by the state of Wisconsin.

Education Required:

Master's Degree in Behavioral Sciences or related field.

Experience Required:

Typically requires 5 years of experience in case management, and clinical service delivery for common Behavioral Health diagnosis.

Knowledge, Skills & Abilities Required:

Training and experience in a broad range of mental health and substance abuse treatment in an inpatient or outpatient facility.

Clinical expertise in effectively managing emotional, psychosocial and spiritual needs of patients throughout the care continuum.

Critical thinking skills to independently identify and prioritize the needs of patients using sound judgment and strong problem-solving skills.

Knowledge of a variety of healthcare specialties, including levels of care, system identification and proven treatment recommendations.

Ability to develop rapport and maintain positive, professional relationships with a variety of patients, caregivers and providers.

Proven ability to independently organize and prioritize work, manage multiple priorities and maintain a flexible schedule in a fast paced, dynamic environment.

Excellent communication skills demonstrating empathy, respect, open-ended questions, active listening and diplomacy with a diverse population. Ability to complete requirements of agency and program/department orientation.

Demonstrated proficiency in technology with computers, internet, electronic health record, and multiple line telephone system.

Ability to multitask having knowledge of documentation techniques for communication.

Physical Requirements and Working Conditions:

Exposed to a normal office environment.
Must have functional vision, touch, speech, and hearing.
Required sitting a majority of the workday.
Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.