18 days old

Children's Behavioral Health Case Manager I/II - 014479 (RN or Licensed Behavioral Health Professional)

Excellus Health Plan Inc.
Buffalo, NY 14202
  • Job Code
    CHILD007868

Summary
This position conducts case management program and clinical activities for the Foster Care Children population (including the Case Management process and quality improvement) in accordance with all Plan, Regulatory and Accreditation standards (ex. Corporate Medical Policies, Medicare & Medicaid Services (CMS); Department of Health (DOH); Case Management Society of America (CMSA); National Committee for Quality Assurance (NCQA); Utilization Review Accreditation Commission (URAC). Additionally, the incumbent implements the Case Management process to facilitate quality, and cost effective medical benefits management.


Essential Responsibilities/Accountabilities
Level I:
Maintains knowledge of all current CMSA Standards, Case Management Program activities, and performs the activities as directed by departmental policy and leadership and mandated Federal and State regulations.
Carries out job responsibilities in accordance with departmental, corporate, state, federal and NCQA/URAC accreditation standards, as well as within the scope of practice and licensure as outlined in the New York State Nurse Practice Act, Article 139 or for Social Workers New York State Laws and Regulations Article 154.
Maintains confidentiality and conducts information management procedures per corporate and departmental policy
Implements all case management processes per department policies, procedures and guidelines.
Screens members that fall within the defined populations served, referred to the department, either by data analysis or by internal or external referral sources.
Works in collaboration with members physicians and other health care providers to assess the needs of the member, facilitate development of an interdisciplinary plan of care, coordinates services, evaluates effectiveness of services and modifies the member plan of care as necessary
Provides appropriate resources and assistance to members with regards to managing their health care across the continuum of care.
Maintains updated information related to appropriate community resources and serves as an information source for providers and other members of the health care team, and as a liaison between such providers and the community resources staffs.
Participates in interdepartmental coordination and communication to ensure delivery of consistent and quality health care services.
Accepts responsibility for continuing education relative to professional growth and meets or exceeds the minimum continuing education requirements per policy and individual professional certification standards, if applicable.
Participates in the education and collaboration with network providers, support staff and members as part of the plan of care or program development.
When necessary, case managers are responsible for monitoring the activity and collaborating with other community based Case Managers (i.e. Health Homes) that affects the case management process and outcomes. Continuous collaboration is necessary to assure continuity and coordination of care.
Measurement of job performance includes meeting established corporate and department standards in terms of volume and accuracy as measured by audit.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.

Level II performs similar functions as level I, as well as:
Acts as the subject matter expert and point of contact for the department.
Provides leadership and guidance to staff.
Offers process improvement suggestions and participates in the solutions of more complex assignment and larger caseloads.
Mentors newer, less experienced staff.
Works independently in coordinating and collaborating with members and providers, resulting in improving member and community health.

Minimum Qualifications

NOTE:
We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

Level I:
RN with current New York State license (BSN Preferred) or Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Mental Health Counselor (LMHC) in New York State
Minimum of three years clinical experience (community health, behavioral health, and managed care experience preferred).
Knowledgeable in Childrens health and BH services, Home and Community Based services (HCBS), Evidence Based Practice (EBPs), Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services and other social service programs.
Knowledge of Health Homes, NYS child serving system and community and family based child serving systems.
Certification as a case manager preferred; required within 3 years of employment as a case manager.
Excellent written and verbal communication skills.
Computer experience and use of measurement/criteria.
Ability to work long hours on computer
Strong interpersonal skills.
Must have the ability to travel.

Level II:
Minimum of four years clinical experience (community health, behavioral health, and managed care experience preferred).
Ability to take on broader responsibilities.
Be an expert in the technology of the job.
Ability to participate in training new staff.
Be part of committees and able to lead some committees.

Physical Requirements

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The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and
qualifications deemed essential to the position.

Equal Opportunity Employer

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractors legal duty to furnish information. 41 CFR 60-1.35(c)

RN





Posted: 2022-05-10 Expires: 2022-06-08
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Children's Behavioral Health Case Manager I/II - 014479 (RN or Licensed Behavioral Health Professional)

Excellus Health Plan Inc.
Buffalo, NY 14202

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