Case Manager (Managed Care Coordinator)

MUST LIVE WITHIN 50 MILES OF THE ARLINGTON PULSEPOINT

A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

The Case Manager (Managed Care Coordinator) is responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract.

How you will make an impact:

• Performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination and management of member's program needs.

• Using tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high risk complications) and coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order to provide care coordination support.

• The process does not involve clinical judgment.

• Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of services.

• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, and physicians. Identifies members that would benefit from expanded services.

• Travels to worksite and other locations as necessary.

Minimum Requirements:

• Requires BA/BS degree

• A minimum of 1 year of experience working directly with people related to the specific program population or other related community based organizations; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• BA/BS degree field of study in health care related field preferred.

• Specific education and years and type of experience may be required based upon state law and contract requirements.

• QMHP certification

• Behavioral/Mental Health experience

• For MMP, requires Community Health Worker certification to be obtained within one year of employment.