Customer Service Representative Swansea MA PartTime

Cardis Furniture & Mattresses; Portland (OR); Remote; USD 71,000 - 88,000; Full time

Job summary

A leading healthcare organization is seeking a Behavioral Health Case Manager to work remotely with regional travel. This role involves conducting assessments for individuals with severe mental illness, ensuring appropriate care, and advocating for patient-centered service planning. Candidates should have relevant degrees and QMHP designation with a minimum of 2 years’ experience.

Qualifications

• Graduate degree in a behavioral health field or Bachelor's in nursing.
• Qualified Mental Health Professional (QMHP) designation required.
• 2 years' experience with severe mental illness.

Responsibilities

• Conduct face-to-face assessments to create and maintain a PCSP.
• Provide advocacy and service coordination.
• Ensure care delivery as per PCSP and perform prior authorizations.

Skills

Assessment Skills

Advocacy

Treatment Planning

Clinical Review

Education

Graduate degree in social work, psychology, or other behavioral health science

Bachelor’s degree in nursing (with relevant training)

Job description

Comagine Health is looking for a Behavioral Health Case Manager to work remotely, with regional travel to perform in-person assessments. Comagine Health partners with the Oregon Health Authority (OHA) to provide statewide eligibility determination, service coordination, medical appropriateness reviews, and transition planning for individuals diagnosed with serious and persistent mental illness (SPMI). Our goal is to support adults with SPMI to live in the least-restrictive settings possible by ensuring that necessary and desired supports and services are in place.

Ideally candidates will reside in the Portland metro area with travel of up to 50% throughout the region.

Who is the Comagine Health?

Comagine Health is a non-profit consulting firm that seeks to improve health and to increase the effectiveness and quality of health care. As a recognized Quality Improvement Organization (QIO), we support providers, plans, purchasers, and consumers, and offer services to state and federal agencies and others to help them better manage health care under the existing system and to assess, plan for and implement broader system transformation. We collaborate with academic, government, and nonprofit partners on initiatives funded by NIH, CDC, AHRQ, BJA, SAMHSA, and others. In short, we are changing healthcare at a fundamental level.

What you’ll be doing for us:

• Conducts initial, annual, and as needed face-to-face assessments to create and maintain a tailored PCSP, utilizing LOCUS, the LSI, and review of records.
• Provides advocacy to individuals (and authorized representatives and supports) regarding assessment, patient-centered service planning, service coordination, and transition planning.
• Assists in eligibility determinations as needed.
• Works closely with individuals, providers, facilities, and social service and community organizations to assist individuals in accessing appropriate care.
• Ensures care is being delivered as described in the PCSP, working with providers and individuals to correct services or adjust the PCSP as needed.
• Performs prior authorizations for services.
• Applies clinical review criteria, guidelines, and screens to determine the medical necessity of health care services.
• Consults with physicians or practitioner consultants when reviews fail clinical review criteria, guidelines, and screens
• Follow all determinations, appeals and hearings policies, processes, and contract requirements.

Competencies:

• Demonstrated ability to conduct a behavioral health assessment including the identification of precipitating events, including health and safety risks to self or others.
• Competent in gathering histories of mental and physical health, substance use, and criminal justice system.
• Ability to conduct a mental status examination.
• Competent in providing DSM 5 diagnoses.
• Proficient in developing treatment plans and safety plans.

Required Qualifications:

• Graduate degree in social work, psychology, or other behavioral health science field or Bachelor’s degree in nursing and licensed by the State of Oregon (with relevant training in behavioral health service delivery).
• Qualified Mental Health Professional (QMHP) with designation (QMHP-C or QMHP-R) or provide proof of QMHP application at the time an offer is extended, and certification is obtained within 2 weeks following date of employment; or current, active, unrestricted clinical licensure required.
• 2 year's of experience working with individuals with severe and persistent mental illness.
• Candidates must reside in the geographic area and be willing to travel in their personal vehicle up to 50% of the time to perform in person assessments. Ideally candidates will reside in the Portland metro area with travel of up to 50% throughout the region.

Desired Qualifications:

• Oregon Medicaid knowledge, and knowledge of Oregon Health Plan’s Prioritized List of Health Services preferred.

Salary Range: $71,000 - $88,000

The salary range posted reflects the range that Comagine is willing to pay for this position. Salary is determined by many factors, including but not limited to geographic location of where the employee will perform their job duties in addition to their knowledge, skills, education, and relevant work experience.

Required Skills

Required Experience