Behavioral Health Caseworker

Amerihealth Caritas•North Charleston, SC

1d•Hybrid

About The Position

Responsible for managing and coordinating care, services, and social determinants of health for Members with behavioral health conditions and acute, chronic, and medically complex needs. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care, and barriers to care. The Behavioral Health Case Worker develops a plan of care through shared decision-making with the Member/caregiver and in collaboration with providers and other care team members to improve the Member’s health status and compliance with treatment plans and promote self-management. Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the plan's effectiveness. Review the medication list and help members coordinate pharmacy needs with a community pharmacist to ensure medication reconciliation is completed when any changes occur. Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the Member/caregiver's progress, needs, and preferences. Establishes points of contact in order to collaborate with identified community, medical, and/or behavioral health teams. Maintain timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable. Monitor appropriate utilization and coordinate services with other payer sources, make appropriate referrals, and identify and escalate quality of care issues. Develop a working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements. May identify cases to be presented at care management rounds and follow up with providers on recommendations to achieve optimal outcomes for Members. Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support our culturally and demographically diverse Member population. Conduct Face-to-face visits at the Member’s residence, provider’s office, hospitals, other acute locations, or community locations for education and/or assessment. Travel required. Must have valid driver's license, reliable transportation and auto insurance.

Requirements

Bachelor's Degree in a related field (e.g., social work, health science, psychology, sociology, early childhood education).
2 years of proven professional experience working directly with SMI members (Serious Mental Illnesses) aged six and up who may have Psychotic Disorders, Bipolar Disorders, or Major Depression.
2 years of social services experience, engaging with clients (e.g., individuals, families, communities), assessing their needs, connecting them to services, and monitoring their progress.
Proficiency using MS Office (Word, Excel, Outlook), internet applications, and electronic medical record and documentation programs.
Experience with Electronic Case Management Platforms (e.g., Jiva).
Strong documentation and record-keeping skills, emphasizing accuracy and adherence to established methods.
Proven professional expertise in assessing members' situations, developing care plans, and teaching self-management.
Skilled in working one-on-one with members, effectively communicating preventative health and management philosophies.
Skilled in presenting health education materials to both individuals and small groups.
Valid driver's license, reliable transportation, and auto insurance.

Nice To Haves

Master's prepared will be given preferred consideration.

Responsibilities

Manage and coordinate care, services, and social determinants of health for Members with behavioral health conditions and acute, chronic, and medically complex needs.
Serve as the primary point of contact for the care team, including Members, physicians, and community supports.
Develop a plan of care through shared decision-making with the Member/caregiver and in collaboration with providers and other care team members.
Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the plan's effectiveness.
Review medication lists and help members coordinate pharmacy needs with a community pharmacist.
Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts.
Establish points of contact to collaborate with identified community, medical, and/or behavioral health teams.
Maintain timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms.
Monitor appropriate utilization and coordinate services with other payer sources.
Make appropriate referrals and identify and escalate quality of care issues.
Develop a working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements.
Identify cases to be presented at care management rounds and follow up with providers on recommendations.
Support a positive workplace environment, collaborate, and share clinical knowledge and skills.
Conduct Face-to-face visits at the Member’s residence, provider’s office, hospitals, other acute locations, or community locations for education and/or assessment.