The purpose of Behavioral Health Case Manager role is to provide support to patients, their families, and physicians in addressing behavioral health and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community.

ACCOUNTABILITIES: 

Member Focus

Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient’s unique needs.

Identifies interventions and resources to assist member reaching personal health related goals.

Identifies patterns and episodes of care that are predictive of future needs and services.

Integration

Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.

Facilitates integration of patient care by encouragement of effective communications between patients, families, providers, health plan and care system programs, and community-based services.

Adheres to policy and procedure in daily activities.

Coordinates service coverage with appropriate funding sources when indicated.

Communication

Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.

Provides regular reporting of member outcomes to behavioral health leadership according to defined process.

Identifies and promptly reports potentially adverse situations to department leadership.

Identifies and promptly reports high cost cases for reinsurance.

Maintains confidentiality of information in accordance with department and corporate policies.

Relationships and Team Building

Establishes and maintains good working relationships within the Behavioral Health Improvement and Operations Department, with other HealthPartners Departments, and with other health team participants.

Supports other team members in achieving patient centered goals.

Assists supervisor in maintaining a cohesive team by contributing to a collaborative, respectful, and diverse environment.

Participates in and contributes to appropriate departmental and/or organizational meetings.

Acts as a liaison between internal customers, Marketing, Sales, Claims and Member Services to resolve systems/process issues.

Technology

Maintains knowledge of and effectively uses automated applications and systems.

Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor.

Maintains maximum individual productivity through proficient use of automated systems.

Personal Development

Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of case management, patient care services, and benefit packages for development of effective case management skills.

Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.

Maintains current, active Minnesota licensure.

Other Duties

Willingly participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.

Performs other duties as assigned.

REQUIRED QUALIFICATIONS: 

Licensed in Minnesota as LICSW, RN or Psychologist, Masters degree preferred.

Minimum of 3 years clinical practice experience; minimum of 3 years relevant utilization review, discharge planning, or case management experience; and current clinical knowledge.

Demonstrated effective, clinical judgement and skills.

Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication.

Demonstrated working knowledge of QI, UM, benefit plans fiscal management, and various payment methodologies preferred. Understanding of healthcare and/or HMO industry.

Demonstrated skill in effective use and management of automated medical management systems.

Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.

Ability to organize and prioritize multiple assignments within workload.

Ability to deal with change and ambiguity.

DECISION-MAKING:

Makes independent decisions within the scope of this position’s accountabilities and determines the need for and the timing of consultation with behavioral health leadership.

Uses sound judgement, organizational knowledge, industry knowledge, and common sense in determining appropriate alternatives for members/patients/families, consulting with leadership and/or Medical Director, when indicated.

Utilizes the member contract coverage policy on-line benefits, level of care guidelines and Member or Claims Services on-line policies and procedures.

Makes recommendations to leadership regarding policy development needs and/or changes.

MAJOR CHALLENGES:

Maintaining member focus in a rapidly evolving environment.

Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the department.

Maintaining timely, comprehensive reviews with concise documentation of pertinent facts, decisions and rationale.

Maintaining appropriate use of supervisory and consultation resources