Case Manager (Bilingual Required)

Bcbsla; Louisiana; On-site; USD 65,000 - 80,000; Full time

Job summary

Louisiana Blue is seeking a Behavioral Health Case Manager in Louisiana. You will assess members, develop and monitor care plans, and coordinate services across care settings. Collaboration with internal teams and providers ensures timely, appropriate care.

Responsibilities include crisis response, care transitions, documentation, and participation in after-hours crisis line coverage. Requires clinical licensure and 3+ years of case management experience in managed care or health insurance

Qualifications

• Bachelor's degree in nursing or related field or Master's degree in social work, counseling, or behavioral health.
• RN license in Louisiana or LPN license in Louisiana with 2 years of related experience as alternative qualifications.
• Minimum of three years of experience in case management including behavioral health or crisis intervention.
• LPC, LCSW, LMFT, RN, or LPN license required.
• Experience with Medicare and Commercial populations; familiarity with CPT codes and billing practices.

Responsibilities

• Conduct comprehensive behavioral health assessments to identify member needs, strengths, and goals.
• Develop, implement, and monitor individualized care plans.
• Coordinate behavioral health services across inpatient, outpatient, and community-based settings.
• Facilitate level of care transitions and follow-up after hospitalizations or emergencies.
• Provide education and support to members and families on behavioral health conditions and resources.
• Collaborate with Utilization Management, Customer/Member services, and providers to ensure integrated care.
• Document all case management activities per regulatory and organizational standards.
• Participate in crisis line staffing and after-hours coverage as scheduled.

Skills

Behavioral health assessment

Care planning

Crisis intervention

Collaboration

Education

Bachelor's degree in nursing or related field

Master’s degree in social work or behavioral health

Tools

Electronic Health Records

Case management systems

Job description

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. Residency in or relocation to Louisiana is preferred for all positions.

Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support. Louisiana Blue will not provide current or future employment-based immigration sponsorship or other immigration support for this opportunity, including H-1B, L-1, O-1, H-1B1, E-3, TN, or J-1 sponsorship or F-1 OPT/STEM OPT/CPT support. Applicants who would require such sponsorship or employer support during their employment should not pursue this opportunity.

Telephonic or in-person, coordination and management of behavioral health services for members enrolled in both Medicare and Commercial insurance plans. This role involves comprehensive assessment, evaluation, care planning, service coordination, and ongoing monitoring to ensure members receive timely, appropriate, and effective behavioral health care. The Behavioral Health Case Manager will collaborate with internal teams, external providers, family members, and community resources to support members in optimizing care and improving health outcomes. Will also receive and resolve crisis calls from plan members and provide immediate crisis intervention, risk assessment, and coordination of emergency services as needed.

• Conduct comprehensive behavioral health assessments to identify member needs, strengths, and goals.
• Develop, implement, and monitor individualized care plans in collaboration with members, families, and providers.
• Identify and coordinate behavioral health services across the continuum of care, including inpatient, outpatient, and community-based services.
• Facilitate level of care transitions and ensure follow-up after hospitalizations or emergency interventions.
• Provide education and support to members and families regarding behavioral health conditions, treatment options, and community resources.
• Collaborate with Utilization Management, Customer/Member services, medical case managers, primary care providers, and behavioral health specialists to ensure integrated care.
• Document all case management activities in compliance with regulatory and organizational standards.
• Participate in interdisciplinary case rounds and quality improvement initiatives.
• Actively participate in staffing the company's 24/5/365 crisis call line, providing immediate crisis intervention, risk assessment, and coordination of emergency services as needed. Regularly participate in the schedule rotation to ensure staff availability to immediately answer crisis calls outside of normal business hours to include weekends and holidays.
• Maintain up-to-date knowledge of behavioral health best practices, regulatory requirements, and community resources.

• Bachelor’s degree in nursing, healthcare, or a related field OR master’s degree in social work, counseling, or behavioral health
• RN license in Louisiana can replace Bachelor's degree OR LPN license in Louisiana + 2 years of related experience can replace the bachelor’s degree
• Minimum of three years of experience in case management which includes behavioral health, behavioral health clinical practice, or behavioral health crisis intervention
• LPC, LCSW, LMFT, RN, or LPN license required
• Strong understanding of behavioral health diagnoses and treatment modalities
• Proficiency in electronic health records and case management systems
• Ability to make decisions based on established policies and procedures
• Case Management Certification preferred but must be attained within 3 years after date of hire
• Experience working with Medicare and Commercial populations
• Experience in a managed care or health insurance setting
• Familiarity with CPT codes and billing practices.

Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.

Job duties are performed in a normal and clean office environment with normal noise levels.

The ability to comprehend, document, calculate, visualize, and analyze are required.

In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.