Behavioral Health Case Mgr

The Hartford•Sunrise, FL

11h•Hybrid

About The Position

We’re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help others accomplish theirs, too. Join our team as we help shape the future.

Requirements

3-5 years of direct clinical practice experience post master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
Licensed independent Behavioral Health clinician in state of service with unrestricted license.
Minimum of a Master’s degree in Behavioral/Mental Health or related field.
Registered nurse with active licensure; with behavioral health/mental health experience.

Nice To Haves

Case management and discharge planning experience preferred
Managed care/utilization review experience preferred
Crisis intervention skills preferred

Responsibilities

Monitors the medical treatment to ensure quality, effective, and cost-efficient care.
Conducts comprehensive evaluations of disability claimants' functionality via functional assessments.
Independently reviews and interprets clinical information and utilizes established clinical guidelines and protocols.
Drives the crisis support initiative for the disability organization by assessing crisis situations and initiating the threat protocol process when deemed clinically appropriate.
Advises on highly complex claims at multidisciplinary clinical review roundtables to ensure optimal outcomes.
Determines when claims contain quality of care issues and escalates these through established channels.
Independently conferences with treating providers and/or other higher level facilities to evaluate clinical symptomatology present in claimants being managed.
Leverages resources such as vocational rehabilitation, risk management unit, physician reviews, home assessments, etc.
Manages risk and resources on highly complex behavioral health claims.
Identifies appropriate return to work options and/or barriers in order to partner with internal resources and ensure a smooth transition to employability and normal activities.
Reviews clinical integration systems and determines appropriate referral resources to achieve optimum level of health.
Supports the leadership team by demonstrating understanding of customer needs and expectations as well as ensuring performance objectives are met, contributing to the success of the organization.
Ensures excellent documentation that clearly and concisely communicates focus of functionality vs. impairment and provides a recommendation of support or non-support of clinical findings.
Collaborates with Disability Benefits Manager and other key players (vocational rehabilitation consultants, medical nurse reviewers, etc.) for proactive movement of claim to resolution.
Manages STD to LTD transition on all behavioral health claims, coordinating with all resources necessary to ensure a seamless process.