HP3 MCI

APS Health Care PR; San Juan (PR); On-site; USD 42,000 - 60,000; 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, coordinating care with providers and community resources.

The role emphasizes telephonic assessments, crisis intervention, and documentation per CMS guidelines, with emphasis on behavioral health and chronic disease management.

Qualifications

• Bachelor's in Behavioral Health required or equivalent.
• Minimum 2 years in clinical, behavioral, or managed care.
• Knowledge of chronic illnesses and disease management.
• Strong telephonic assessment and customer service skills.
• Proficient with MS Office applications (Word, Excel, PowerPoint, Outlook).

Responsibilities

• Conduct health risk assessments and identify barriers to treatment adherence.
• Communicate with community providers to develop care plans.
• Follow up via phone or community outreach and crisis intervention as needed.
• Provide chronic care management and care coordination activities.
• Educate patients about their disease state and plan of care.
• Collaborate with professionals to improve treatment results.
• Review and maintain data related to treatment and services.
• Establish case discussions with Medical Consultant or Medical Director.
• Represent the company in court for follow-up cases and prepare reports.
• Document all activities per APS policies.
• Comply with CMS guidelines and regulatory requirements.
• Perform other duties as assigned.

Skills

Telephonic assessment

Care coordination

Empathetic communication

Crisis intervention

MS Office proficiency

Education

Bachelor's Degree in Behavioral Health

Master's Degree preferred

Tools

Microsoft Word

Microsoft Excel

PowerPoint

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:

• Bachelor’s Degree in a Behavioral Health field; Master’s Degree 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.