Healthcare Case Manager

VIVA USA Inc; Louisville (KY); On-site; USD 65,000 - 75,000; Full time

Job summary

VIVA USA Inc is seeking an Intensive Case Manager for a field-based position in Kentucky, requiring 80-90% in-state travel. You will provide advocacy, coordination, and education to improve member health outcomes and manage healthcare costs.

You will assess needs, coordinate wellness plans, and collaborate with providers, Medical Directors, and health programs to achieve optimal results. Bachelor's or Master’s in behavioral health or related field preferred.

Qualifications

• Minimum 6 months experience in Foster Care and juvenile justice systems or equivalent.
• Minimum 2 years experience in behavioral health or related fields.
• Minimum 1 year of experience with MS Office applications (Word/Excel).
• Willing and able to travel 80–90% of time within the assigned region.
• Bachelor’s or Master’s degree in behavioral health or related field is required.

Responsibilities

• Provide comprehensive healthcare management services to facilitate appropriate treatment and cost control.
• Advocate, coordinate, educate for members through care management tools and resources.
• Identify high risk factors and implement proactive support interventions.
• Coordinate wellness care plan activities and monitor member needs.
• Engage with providers and programs to overcome barriers and improve outcomes.

Skills

Foster care experience

Juvenile justice experience

Behavioral health experience

Social services experience

MS Office proficiency

Education

Bachelor’s or Master’s degree in behavioral health or related field

Tools

MS Office Suite

Word

Excel

Job description

This is a Field position that requires regional in-state travel 80-90% of the time.

Intensive Case Manager utilizes critical thinking and professional judgment to support the case management process, in order to facilitate and maintain improved healthcare outcomes for members by providing advocacy, collaboration coordination, support and education for members through the use of care management tools and resources.

Position Summary

Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues

Evaluation of Members:

Through the use of care management assessments and information/data review, recommends an approach to resolving care needs maintaining optimal health and well-being by evaluating member’s benefit plan and available internal and external programs/services.

Identifies high risk factors and service needs that may impact member outcomes and implements early and proactive support interventions.

Coordinates and implements Wellness care plan activities and monitors member care needs.

Enhancement of Medical Appropriateness and Quality of Care:

Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.

Identifies and escalates quality of care issues through established channels.

Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.

Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

Helps member actively and knowledgably participate with their provider in healthcare decision-making.

Monitoring, Evaluation and Documentation of Care:

Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Duties

• Determines medical necessity/ appropriateness
• Facilitates optimal outcomes
• Identifies and follow through with continuous quality/ compliance opportunities . May also include identification of aberrance's and initiation of corrective action
• Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy
• Optimize total costs
• Implementation and evaluation of policy based on usage and program directives
• Educate/empower colleagues at all levels to enable decision making at most appropriate level

Required Qualifications :

• Minimum 6 months experience in Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services or evidence-based practices applicable to the KY populations, is required.
• Minimum 2 year of experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
• Minimum 1 year of experience in MS Office Suite applications, including Word and Excel.
• Willing and able to travel 80-90% of their time to meet members face to face in their assigned region.

Preferred Qualifications

• 3+ years' experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
• 1+ MCO experience.

Experience

• Minimum 5 years of relevant experience

Education

Minimum of a Bachelor’s Master’s degree or a non-licensed master level clinician is required; with either degree being in behavioral health or a relevant human services field of study required (social work, psychology, marriage and family therapy, counseling).

This is a Field position that requires regional in-state travel 80-90% of the time. Qualified candidate must have reliable transportation. Travel to the office for meetings and training is also anticipated. Travel to member's homes, schools, hospitals, doctor's offices, DCBS offices etc. is expected for member face to face time. Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm EST, is required. We are serving the needs of children and families that may require working after school, after work, etc.

Notes:

Field position

M-F 8am to 5pm with flexibility to work until 7pm.

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status