New Directions Behavioral Health Manager, Case Management - Remote in Remote, Florida

This position allows your to work from an office in your home and requires you maintain high-speed internet service. This position requires a Florida license at the time of hire.

ROLE AND RESPONSIBILITIES

The Manager, Case Management provides functional and administrative oversight of Case Management programs and related Quality Improvement activities. The Manager is responsible for achieving outcome measures associated with the case management program and maintaining compliance with NDBH policies and procedures, regulatory and accreditation standards and contractual performance guarantees. The Manager is also responsible for reporting team performance and metrics in the applicable committees. The Manager assists with development and implementation of programs, policies and procedures and software systems relevant to the Case management team. The Manager regularly interfaces with multiple internal departments and external entities to facilitate the provision of contracted services and plan for future programs and activities. Work is closely coordinated with Customer Service, After Hours Service, Network Operations, Physician Reviewers, management and other staff within New Directions; client company representatives as well as all stakeholders within the behavioral health system to ensure efficient and effective management of all members and their needs. The Manager of Case Management also provides direct supervision of clinical and non-clinical staff. The Manager will also provide on-call evening, weekend, and holiday supervision for after-hours staff as needed and assigned.

reevaluated continuously throughout the year.

ESSENTIAL FUNCTIONS

• Provides leadership for the Case Management team, effectively and positively communicating corporate initiatives and motivating team members to adopt changes to enhance clinical outcomes and improve value for the customers

• Promotes quality service delivery and effective care transitions planning for optimal member health outcomes

• Provides and/or coordinates training activities

• Provides clinical supervision and administrative oversight to CM staff working with members to coordinate, collaborate, and connect services in support of post-discharge stabilization activities and movement toward self-management

• Provides timely feedback, performance reviews and performance management for CM team staff on a regular basis to improve clinical outcomes for members, reduce readmissions and contribute to the value proposition for customers

• Provides caseload management and ensures that the team is working efficiently and effectively

• Provides case consultation for complex cases and situations

• Demonstrates clinical expertise in response to a variety of circumstances ranging from crisis intervention to routine business matters

• Provides education to facilities, providers and members about the case management processes and as needed, utilization processes

• Promotes coordination with Health Plan medical management and medical services providers, including primary care physicians and patient centered medical homes, to promote integrated member health care.

• Provides clinical and administrative oversight for CM programs and related Quality Improvement activities. Provides reporting for programs and activities in the appropriate committee.

• Facilitates daily stand meetings, team meetings, and clinical rounds, which will include clinical case and chart reviews of high risk, high cost cases and other cases upon request of supervisor, medical director or as required by policies and procedures.

• Conducts phone and chart audits and monitors individual and team scorecards. Audits will also include to monitoring for compliance with NDBH policies and procedures as well as regulatory and accreditation standards. Provides feedback and follow-up to staff as needed to improve compliance, standardization or productivity

• Monitors daily, weekly and monthly reports related to case management and care transitions to ensure that targets are met

• In response to escalated complaints, concerns or issues, provides information to members, providers and client company representatives within applicable regulatory guidelines

• Provides and/or coordinates education and training for employees and orientation for new staff

• Collaborates with members, providers, and client companies to facilitate member access to appropriate treatment to meet their behavioral and/or physical health needs and community supports to assist them with self-management of their health.

• Facilitates positive interaction and collaboration with client entities to maintain client satisfaction and contract compliance

• Accepts responsibility for follow-up and support services provided to NDBH members.

• Facilitates positive interaction and collaboration with client entities to maintain client satisfaction and contract compliance

• Assists with implementation of new business/accounts as needed

• Stays current with New Directions’ technology, member Behavioral Health benefits, and non-health community resources and ensures that staff is as well

• Utilizes appropriate tools such as NDBH approved case management models, assessment instruments, practice guidelines, and other applications and tools. Ensures staff compliance with utilization of appropriate and standardized tools.

• Participates in committees and projects as assigned

• Assists with the development and implementation of new programs, policies and procedures, and software as assigned by Director

• Makes recommendations of programs and/or systems that create improved outcomes and timeliness of the care management department

• Contributes to site specific audits/surveys/research projects that are relevant to care management process, policies, and procedures

• Participates in on-going continuing education as required by professional licensure, certification, or as requested by New Directions and maintains clinical licensure and certifications

• Maintains CM team compliance with NDBH policies and procedures, regulatory and accreditation standards and contractual performance measures.

This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities as deemed necessary.

EDUCATION & EXPERIENCE

REQUIRED

• Current, unrestricted license issued by a state or territory of the United States to practice independently as a Clinical Social Worker, Marriage and Family Therapist, Professional Counselor, Clinical Psychologist or Registered Nurse in the state in which the business operation is located and/or other states as required by law, regulation or contract. For Registered Nurses, a Bachelor’s Degree in Nursing is required.

• Minimum of five (5) years post-licensure experience in direct clinical care with patients in facility-based and/or outpatient psychiatric or chemical dependence treatment

• Previous experience in Case Management or Disease Management

• Knowledge & ability to apply case management principles and concepts to their case management practice

• Extensive clinical knowledge base

• Excellent verbal and written communication skills and interpersonal skills are essential

• Ability to comprehend medical policy and criteria and clearly articulate health information

• Experience and training in Motivational Interviewing Or Health Coaching

• Strong computer and keyboarding skills (Microsoft Outlook and Word), including the ability to document while simultaneously while taking information over the phone

• Ability to obtain certification in Case Management (CCM) within 3 years of hire

• Ability to travel 10-30%

PREFERRED

• A minimum of one (1) year of supervisory experience

• Previous experience in managed care

• Current certification in Case Management (CCM)

• Strong computer skills including MS Office suite

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.

Qualifications