Remote Behavioral Health Case Manager

Blue Cross & Blue Shield of Rhode Island; Providence (RI); Hybrid; USD 74,000 - 110,000; Full time

Job summary

Blue Cross & Blue Shield of Rhode Island seeks a Behavioral Health Care Manager to direct and coordinate a beneficiary’s care. You will complete the Health Risk Assessment with D-SNP members and develop and maintain Interdisciplinary Care Plans across the care continuum.

Educate beneficiaries and caregivers on self-management and collaborate with team members to meet SMART goals. You will conduct assessments, coordinate with providers, health navigators, and care coordinators, and support

Qualifications

• LICSW or LMHC license required in RI.
• CCM certification must be obtained within 3 years of employment.
• 3–5 years’ experience in a medical/clinical environment or managed health plan.
• Knowledge of utilization management and care coordination.
• Understanding of population health and chronic condition management.
• Excellent verbal and written communication; strong problem-solving and decision-making skills.

Responsibilities

• Manage members through the behavioral healthcare delivery system; assess needs to identify interventions.
• Conduct health assessments (telephonic or in person) to identify high-risk members.
• Coordinate communication among members, providers and caregivers to implement action plans.
• Identify opportunities to impact claims expense trends for all lines of business.
• Evaluate and modify action plans with members and providers as needed.
• Monitor and evaluate patient services to ensure appropriate coordination of care.
• Collaborate with Utilization Review for pre-authorization, concurrent review and discharge planning.
• Promote member and provider satisfaction by understanding member benefits.
• Provide continuity of care by building relationships with members, families and providers.
• Participate in department initiatives and projects; conduct community-based visits as required.
• Bi-lingual candidates preferred.

Skills

Verbal communication

Written communication

Negotiation skills

Problem-solving

Time management

Presentation skills

Education

LICSW or LMHC license

CCM certification within 3 years

Job description

Blue Cross & Blue Shield of Rhode Island seeks a Behavioral Health Care Manager to direct and coordinate a beneficiary’s care. You will complete the Health Risk Assessment with D-SNP members and develop and maintain Interdisciplinary Care Plans across the care continuum.

Educate beneficiaries and caregivers on self-management and collaborate with team members to meet SMART goals. You will conduct assessments, coordinate with providers, health navigators, and care coordinators, and support