Case Manager Behavioral Health (Remote)

highmarkhealth; Pennsylvania; Hybrid; USD 70,000 - 90,000; Full time

Job summary

Highmark Health is seeking a Case Manager to provide comprehensive behavioral health case management services to members. You will assess needs, develop care plans, coordinate services, and monitor progress while containing costs within benefits.

The role requires licensure as a Behavioral Health professional or RN, with 3 years of related experience. Strong assessment, planning, and collaboration skills are essential; travel up to 25% may be required.

Qualifications

• Requires licensure as a Behavioral Health professional or RN with applicable state licensure.
• Experience in case/utilization management and health insurance is preferred.
• Cultural competency and ability to work with diverse populations are valued.

Responsibilities

• Manage a caseload of members with moderate complexity behavioral health needs.
• Serve as primary contact for members, providing coaching and case management interventions.
• Assess health status, needs and resources; develop and implement individualized care plans.
• Coordinate access to services and monitor progress toward goals.
• Collaborate with physicians and providers to ensure effective care.
• Document all activities in compliance with policies and regulations.
• Identify opportunities for cost savings and quality improvement.

Skills

Assessment

Care planning

Independent work

Team collaboration

Education

Master's degree (Behavioral Health)

Associate's degree with RN license

Bachelor's or Master's in Nursing (RN)

Tools

Microsoft Office

Case management software

Electronic Health Records

Job description

Job Summary

This job is responsible for providing comprehensive case management services to members with behavioral health needs, ensuring quality, cost-effective care delivery, and promoting optimal health outcomes. The Case Manager assesses member needs, develops and implements care plans, coordinates services, and monitors progress, while containing the cost of health care services. The incumbent will assist in containing the cost of health care services by detecting, resolving and preventing improper utilization of member benefits.

Essential Responsibilities

• Manage a caseload of members with moderate complexity behavioral health needs.
• Function as a primary contact for members with behavioral health needs with the depth of engagement ranging from coaching interventions to intensive case management interventions.
• Assess members' health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Develop and implement care plans with guidance from senior staff.
• Monitor member progress toward goals and adjust care plans as needed.
• Proactively incorporate lifestyle improvement and prevention opportunities into member interactions and coaching.
• Communicate with the members' treating provider(s) in more complex clinical situations requiring case management interventions.
• Evaluate the effectiveness of interventions and services.
• Act as an advocate and liaison to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services. This is accomplished by using communication and available resources to promote quality, cost-effective outcomes in accordance with available contract benefits.
• Work collaboratively and communicate clearly and professionally with physicians, providers, co-workers and other members of the health care team to carry out the established plan of care.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements, company policies, regulatory requirements and accreditation standards.
• Identify areas for potential cost savings, quality improvement and workflow efficiencies.
• Other duties as assigned or requested.

Education

Required

• Master's degree if licensed Behavioral Health Professional OR Associate's degree with RN license

Preferred

• Bachelor's or Master's degree in Nursing if licensed as RN

Experience

Required

• 3 years of experience in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance

Preferred

• Experience working with the healthcare needs of diverse populations
• Experience demonstrating understanding of importance of culture competency in addressing targeted populations

Licenses and Certifications

Required

Any of the following:

• Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
• Licensed Social Worker (LSW)
• Licensed Clinical Social Worker (LCSW)
• Licensed Master Social Worker (LMSW)
• Licensed Professional Counselor (LPC)
• Licensed Mental Health Counselor (LMHC)
• Licensed Marriage and Family Therapist (LMFT)

Preferred

• Certified Case Manager (CCM)

Skills

• Strong assessment and care planning skills.
• Ability to work independently and as part of a team.
• Proficiency in using Microsoft suite of applications, case management software and electronic health records.
• Understanding of healthcare systems and case management principles.
• Language (Other than English): None

Travel Requirement

0% - 25%

Physical, Mental Demands and Working Conditions

Position Type Office-based

Physical work site required Yes

Disclaimer

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's responsibility t