HP3 MCI

APS Health Care PR; Guayama (PR); On-site; USD 60,000 - 85,000; Full time

Job summary

APS Health Care PR seeks a Health Professional 3/MCI to provide intensive follow-up for members at risk of nonadherence, aiming to prevent hospitalizations and deteriorating mental health status. The role involves telephonic follow-ups, home visits when needed, and coordination with community agencies to support treatment plans.

You will educate patients about their conditions, collaborate with a medical team, document all activities, and ensure compliance with CMS guidelines and company

Qualifications

• Master’s degree in a Behavioral Health field required.
• Current, unrestricted license to practice preferred.

Responsibilities

• Conducts health risk assessment and identifies barriers to treatment adherence.
• Communicates with community providers to develop care plans.
• Follow-up via telephonic or community outreach and crisis intervention when needed.
• Provide chronic care management and care coordination.
• Educates patients about their disease state and related health issues.
• Collaborates with professionals to improve treatment results.
• Investigates and maintains data related to treatment and services.
• Establishes case discussions with Medical Consultant/Director.
• Represents the company in court for cases under follow-up and prepares reports.
• Documents activities per APS policies.
• Complies with CMS guidelines and other regulations.
• Performs any other duties assigned by management.

Skills

Health risk assessment

Telephonic assessment

Customer service

Crisis intervention

Data/documentation

MS Word

MS Excel

MS PowerPoint

MS Outlook

Collaboration with providers

Community resources knowledge

Education

Master’s Degree in Behavioral Health

Tools

MS Word

MS Excel

MS PowerPoint

MS Outlook

Job description

The Health Professional 3/MCI its responsible for providing intensive follow-up to members exhibiting behavior or an environment that may predispose them to incompliance with medical treatment thus resulting in increased hospitalizations, costly treatments and/or worsening of their mental health status. Intensive follow-up may consist of telephonic follow-ups, home visits, integration and coordination care with community agencies and coordination depending on the necessity.

Essential Functions:

• 1. Conducts health risk assessment and identifies barriers that could affect or interfere with treatment effectiveness or adherence
• 2. Communicates with providers in the community regarding the consumer’s treatment needs and develops appropriate care plans for specialized needs of members
• 3. Follow-up by telephonic or/and community outreach and crisis intervention if necessary.
• 4. Provides chronic care management, empowerment, motivational interviewing, services coordination and other clinically based activities as assigned, based upon member’s severity of condition.
• 5. Educates the patient about their disease state as well as other health issues relating to their plan care.
• 6. Collaborates with other professionals to obtain better treatment results and overall care
• 7. Investigates, reviews and maintains data related to treatment, care and/or related services
• 8. Establish case discussions with Medical Consultant and/or Medical Director
• 9. Will represent the company in Court for cases under follow-up and prepare reports if necessary.
• 10. Documents all activities per APS policies and procedures.
• 11. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
• 12. And all other duties assigned by the manager and/or supervisor.

Education:

• Master ’s Degree in a Behavioral Health field.
• Current, unrestricted license to practice preferred.

Experience:

• Minimum 2 years of experience in a Clinical, Behavioral or Managed Care field preferred.

Knowledge:

• Strong knowledge in behavior principles, chronic illnesses and disease management.
• Strong telephonic assessment and customer service skills.
• Knowledge in community based resources.
• Knowledge in clinical assessment and crisis intervention.
• Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.