Care Manager, BH - WellSense Health Plan

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Care Manager provides telephonic care management services for WellSense members receiving behavioral health (BH) services.The Care Manager works alongside medical Utilization Management and medical Care Management staff, pharmacists, and medical directors as part of an integrated team and follows members through the health care continuum, including acting as the liaison for hospital staff, PCPs, and other healthcare team members in facility discharge planning.

Our Investment in You:

·Full-time remote work

·Competitive salaries

·Excellent benefits

Key Functions/Responsibilities:

• Performs a variety of diverse and complex telephonic care management responsibilities and ensures that all service needs are met through monitoring of treatment plans, crisis plans, and interagency collaboration.
• Manage and carry out all activities of the Care Management Program. This includes accepting referrals, identifying appropriate care management candidates, ensuring that all their service needs are met, and tracking their progress.
• Completes BH Assessments for complex and transition of care cases in a timely manner.
• Conducts BH/SUD screenings for complex and non-complex cases as needed.
• Develops an Individual Care Plan (ICP) per Care Management policy and collaborates with the members’ providers to discuss ongoing care, offer potential solutions to clinical and/or social barriers and obstacles, and serves as a facilitator for future needs of the member.
• Implements treatment plans to assist members to develop the skills needed to successfully live and work as independently in the community as they are able.
• Utilizes technique such as Motivational Interviewing, Harm Reduction, Trauma Informed Care principles, Stages of Change and evidence-based practices to move the member towards readiness to engage in services, medication compliance, etc.
• As needed identifies service delivery gaps and barriers, ensures appropriate evaluation, service planning, and service delivery, and monitors care plan implementation and progress.
• Outreaches to members for medication monitoring and to encourage them to comply with medication regimens. Educates members as needed regarding the role and use of medications in their recovery.
• Works closely with families as appropriate and includes members and their families in service planning.

• Works closely with state agency case management staff, particularly the Department of Mental Health.
• Works in collaboration with other BH staff members, internal and external case managers, other departments, state agencies, providers, and community partners.
• Attends to and takes part in round meetings presenting cases and/or providing recommendations and support to other care managers.

• In all activities works to ensure linkage and integration of behavioral health and medical care.This includes both member-based activities and work with agencies as part of community-based care management.

• Documents clinical assessments and coordination of care in the medical management information system in a timely manner that meets regulatory and accreditation standards.
• Facilitates all regulatory/accreditation correspondence.
• Meets departmental productivity and quality standards; maintains designated caseload volume and adheres to turn around times standards.
• Provides high level of service and satisfaction to internal and external customers
• After-hours availability as needed

• Regular and reliable attendance is an essential function of the position.
• Performs other duties as assigned.

Supervision Exercised:

• No direct supervision exercised

Supervision Received:

• General supervision is received weekly.

Qualifications:

Education:

·A master’s or doctoral degree in a behavioral health field such as psychology, clinical counseling, or social work

Experience:

• Two or more years related experience in Mental Health, BH Case Management, and/or substance abuse treatment

Experience Preferred/Desirable:

• Experience with Medicaid recipients and community services.
• Experience with care management.
• Experience in a health plan or insurance environment
• Previous geriatric psychiatric experience or other related experience with a geriatric population in an integrated medical/behavioral health model strongly preferred

Certification or Conditions of Employment:

• Must hold a current state licensure
• Massachusetts:LICSW, LMHC, LMFT, or LADC-1 (with additional licensure)
• Certified Case Manager (CCM) preferred

Competencies, Skills, and Attributes:

• Able to work in a fast-paced environment, ability to multi-task.
• Experience with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry processing applications.
• Strong analytical and clinical problem-solving skills.
• Demonstrated ability to successfully plan, organize, implement and manage projects within a health care setting.
• Detail oriented and excellent analytical skills.
• Ability to work both independently and as part of a team.
• Strong oral and written communication skills; ability to interact within all levels of the organization.

Working Conditions and Physical Effort:

• Travel to member locations when required.
• Work is normally performed in the community but may require attendance at meetings in the corporate office

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees