Intensive Case Management

APS Health; San Juan, Northern (PR, KY); Hybrid; USD 55.000 - 75.000; Vollzeit

Zusammenfassung

APS Health in Puerto Rico is seeking a Health Professional 3/MCI to provide intensive follow-up for members at risk of non-adherence, with a focus on reducing hospitalizations and improving mental health status.

The role includes health risk assessments, care plan development with community providers, crisis intervention when needed, and coordination of chronic care management and services according to CMS guidelines.

Qualifikationen

• Bachelor’s degree in a Behavioral Health field; Master’s degree preferred.
• Minimum 2 years of experience in Clinical, Behavioral or Managed Care.
• Strong knowledge in behavior principles, chronic illnesses and disease management.
• Proficient with Microsoft Word, Excel, PowerPoint and Outlook.
• Excellent telephonic assessment and customer service skills.

Aufgaben

• Conducts health risk assessment and identifies barriers to treatment adherence.
• Communicates with community providers and develops care plans for specialized needs.
• Follow-up by telephonic or community outreach and crisis intervention as needed.
• Provides chronic care management and services coordination based on member severity.
• Educates patients about their disease state and plan of care.
• Collaborates with professionals to achieve better treatment results.
• Investigates and maintains data related to treatment and services.
• Establishes case discussions with Medical Consultant/Director.
• Represents the company in court for follow-up cases and reports.
• Documents all activities per APS policies and CMS guidelines.
• Performs other duties assigned by management.

Kenntnisse

Telephonic assessment

Customer service

Community resources

Clinical assessment

Crisis intervention

Behavioral health principles

Chronic disease management

Ausbildung

Bachelor’s Degree in Behavioral Health

Master’s Degree preferred

Tools

MS Word

MS Excel

PowerPoint

Outlook

Jobbeschreibung

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.