DSNP Behavioral Health Case Manager

Blue Cross & Blue Shield of Rhode Island•Providence, RI

5d•Hybrid

About The Position

The Duals Special Needs Plan (DSNP), Behavioral Health Care Manager (BH CM) is responsible for assessing members’ behavioral health needs, coordinating care, and creating individualized treatment plans for DSNP members. All work is completed on a scheduled cadence to ensure timely assessment, follow‑up, and care coordination. Treatment plans are specific, measurable, and regularly updated based on the member’s progress. BH CMs use Motivational Interviewing and clinical skills to engage members and support progress toward their health care goals.

Requirements

Active and unrestricted Rhode Island LMHC or LICSW
Three to five years’ experience in a medical/clinical environment or managed health plan
Must obtain Certified Case Manager (CCM) certification within three years of employment
Experience working in a managed care/health maintenance organization
Experience in specialties such as pediatrics, adolescents, and geriatrics.
Knowledge of healthcare plans and benefits.
Knowledge of utilization management and/or coordination of care
Knowledge of population health and chronic condition management principles
Understanding of health care delivery system access points and services
Ability to navigate the healthcare delivery system
Knowledge of business process improvement techniques and strategies
Excellent verbal, written communications and technical skills
Negotiation skills
Presentation skills
Decision-making skills
Good problem-solving skills
Ability to interface with employees at all levels
Ability to effectively navigate ambiguous situations with limited direction
Excellent organizational skills and ability to successfully prioritize multiple tasks
Ability to handle multiple priorities/projects
Strong time management skills

Nice To Haves

Experience working in a managed care/health maintenance organization
Knowledge of healthcare plans and benefits
Knowledge of the Behavioral Health Continuum, specifically Substance Use Resources

Responsibilities

Manage members through the healthcare delivery system, including behavioral health and medical services, by assessing needs and identifying appropriate interventions to address clinical, psychosocial, and functional risk factors.
Conduct telephonic or face‑to‑face behavioral health and comprehensive health assessments to identify high‑risk or emerging‑risk members who would benefit from education, behavioral health interventions, and care management support.
Facilitate communication between members, behavioral health providers, medical providers, and other stakeholders to coordinate care and implement action plans focused on improving the member’s total health, including behavioral health outcomes.
Identify opportunities to positively impact claims expense trends across all lines of business or at the individual member level through effective medical and behavioral health care management interventions.
Evaluate and monitor behavioral health–informed action plans by working collaboratively with members and providers; modify plans as clinically appropriate based on member progress, engagement, and changing needs.
Monitor and evaluate patient services to ensure appropriate coordination of medical and behavioral health care.
Collaborate with the Utilization Review process, including pre‑authorization, concurrent review, screening cases for quality‑of‑care concerns, and discharge planning related to behavioral health services.
Promote member and provider satisfaction by demonstrating working knowledge of member benefits, including behavioral health benefits, health, disability, and other resources available to support the member.
Provide continuity and consistency of care by building positive relationships with the member and family, behavioral health providers, physicians, care coordinators, and the health plan.
Work collaboratively with the interdisciplinary care team and other partners to develop and implement solutions that support behavioral health integration and quality improvement.
Identify barriers to effective care delivery and opportunities for process improvement, while exemplifying corporate values of accountability, collaboration, integrity, and respect.
Participate in department initiatives, quality improvement activities, and projects related to behavioral health and care management.
Perform other duties as assigned.