Behavioral Health Intensive Care Management Coordinator

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Act as an Intensive Case Manager for members diagnosed with specific conditions.

• Conduct assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy for assigned members.

• Collaborate and communicate with members, their families/caregivers, and healthcare professionals.

• Ensure care coordination and case management activities align with members' risk levels, strengths, preferences, needs, and desired outcomes.

• Support the implementation of health management activities and programs.

• Oversee all aspects of assigned programs.

• Carry out in-person assessments in members' homes or the least restrictive environments.

• Engage in meetings related to members’ care.

• Utilize patient information data systems and document relevant information accurately.

• Formulate strategies to enhance effectiveness and participation in health management programs.

• Establish and sustain communication with provider networks, group representatives, and members.

• Conduct research and analysis for monthly, quarterly, and annual reports.

• Comply with NCQA requirements, state and federal regulations, as well as CMSA standards.

• Monitor member compliance, success rates, and quality indicators.

• Identify needs for health management programs and create programs for improvement.

• Develop educational materials for patients and providers.

• Perform additional duties as assigned.

⛳️ Requirements

• A minimum of four years of recent clinical experience in a defined Behavioral Health specialty area, or four years of Behavioral Health utilization review/case management/clinical experience, including two years of clinical work.

• A Bachelor's degree from an accredited university or college in Nursing, Health Administration, Health Promotion, Exercise Science, Education/Training, Social Work, or a related health field, with at least 45 documented training hours pertinent to specialty area issues and treatment.

• Behavioral Health Intensive Case Manager degree equivalency: a four-year degree in nursing, psychology, social work, early childhood education, child development, or a related field, along with a minimum of 45 documented training hours relevant to specialty area issues and treatment.

• At least three years of experience working with individuals with specified health conditions; two years if holding a master’s degree.

• Proficient in word processing, spreadsheet, database, and presentation software.

• Knowledge of insurance and benefit programs related to health management coverage.

• Familiarity with the quality improvement process and national case management standards.

• Capability to work independently, prioritize tasks effectively, make informed decisions, and exercise sound judgment.

• Strong customer service, organizational, presentation, spelling, punctuation, and grammar skills.

• Ability to persuade, negotiate, or influence others effectively.

• Strong analytical or critical thinking skills.

• Capacity to handle confidential or sensitive information with discretion.

• Must be able to drive and be available on nights and weekends.

• Familiarity with evidence-based assessments.

• Proficient in Microsoft Office.

• If RN: must hold an active, unrestricted U.S. and state-of-hire RN license, or an active compact multistate unrestricted RN license.

• If LPN: must have an active, unrestricted U.S. and state-of-hire LPN license, or an active compact multistate unrestricted LPN license.

• If Social Worker: must possess an active, unrestricted LBSW, LMSW, or LISW license from the United States and state of hire or with a state compact.

• For Mental Health Professionals: must have an active, unrestricted LPC, LMFT, LAC, LPES, or Licensed Psychologist license from the United States and state of hire or with a state compact.

• Preferred: experience working directly with individuals suffering from mental illnesses.

• Must reside in the Low-Country Region of South Carolina, preferably in Beaufort County.

• Expected to work Monday to Friday, from 8:30 am to 5:00 pm EST, totaling 40 hours per week.

• In-person member contact and regional travel are required, with a travel limit of three hours one way.

🏝️ Benefits

• Mileage reimbursement after the 50th mile at a rate of 70 cents per mile.

• Subsidized health plans.

• Coverage for dental and vision.

• 401k retirement savings plan with company matching.

• Life insurance.

• Paid Time Off (PTO).

• On-site cafeterias and fitness centers in major locations.

• Education assistance.

• Service recognition.

• National discounts for movies, theaters, zoos, theme parks, and more.

• Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs.