CASE MANAGER (BACHELOR)

UHS•Guaynabo, Puerto Rico

1d•Remote

About The Position

FHCHS of PR, Inc. is an organization with extensive experience in managing mental health benefits and developing solutions that promote the emotional well-being of individuals, families, workplaces, and communities. Since our foundation in 1996, at FHC Mental Health, we have worked to facilitate access to excellent mental health services and support people at different stages of their lives. Our experience has allowed us to evolve, expand our services, and develop integrated solutions that promote prevention, guidance, recovery, and continuity of care. The Case Manager supports the Behavioral Health Contact Center team in responding to individuals in need of services, orientation and/or crisis during the seven days of the week, 24 hours. Case Managers provide case management services and refer members to the appropriate level of care after consulting with the Clinical Manager, Clinical Supervisor, Director, VP of Clinical or Psychiatrist. The Case Manager uses clinical structured data to determine based on eligibility criteria the appropriate services according to members’ needs and benefits under the health plan. The goal of the services provided is to support members’ wellness. The Case Manager is responsible for documenting the services authorization and complying with the established processes to coordinate services with the providers. Case Manager educates and orients members, their representatives and their dependents about the coverage benefits and community resources available. The case manager is responsible for providing support in the coordination and notification of appointments scheduled for our members, in accordance with the timeframes established in the organization's policies. This role also ensures the accessibility and care of the members.

Requirements

Bachelor’s in social work or psychology
Knowledge in Microsoft Office
Customer service
Excellent interpersonal skills
Must be available to work rotating shifts

Nice To Haves

Preferred fully bilingual

Responsibilities

Answer incoming calls within established timeframes, identifying oneself by name, title, and organization as required by Behavioral Health Contact Center (BHCC) standards, while maintaining clear, professional communication and active listening.
Provide support to members by conducting needs assessments, brief interventions, supportive engagement, and facilitating appropriate referrals based on presenting concerns.
Manages the emergency calls in coordination with a licensed clinician, coordinates with emergency services (911), and facilitates immediate access to help.
Maintains immediate access to clinical supervisors, psychiatrists, or licensed clinicians, consulting and escalating cases that fall outside their scope of practice.
Direct members to appropriate levels of care, including outpatient services, inpatient treatment, and community-based resources; collaborate with emergency response services when urgent intervention is required.
Follow internal mandatory reporting procedures for cases involving abuse, neglect, or risk to self or others, and ensure immediate access to emergency services when individuals present suicidal or homicidal ideation or threats.
Verify member eligibility, accurately document call information in organizational platforms, and educate members or authorized representatives on program offerings and benefit coverage.
Conduct structured clinical data collection using approved scripts, perform telephone interviews using the Triage Logic platform, gather clinical and non-clinical information, perform tasks that do not require clinical interpretation, and review service requests for completeness.
Maintain confidentiality of all documents and information received and document services in compliance with HIPAA, Law 408, and internal policies.
Perform outbound calls, send or fax materials, complete TTY validations, conduct referral follow-ups, and complete callback tasks as assigned.
Comply with established quality parameters, including abandonment rate, average speed of answer (ASA), service coordination and notification, call classification and routing, and first call resolution.
Interact with providers, members, and care team professionals to ensure continuity of services; manage emergency calls in coordination with licensed clinicians following BHCC procedures.
Validate admission registration processes for mental health services, input inpatient admission data when facilities are unable to do so, confirm admissions and discharges with psychiatric facilities, and enter related information in the Web Census platform.
Provide UR backup after business hours, including documenting service requests, offering status updates, explaining operational information, processing authorized services, and sending provider notifications.
Participate in assigned projects and mandatory training (Compliance, HR, departmental, URAC, NCQA, CMS), and consistently apply all BHCC-related policies, procedures, Code of Conduct, Ethics, Confidentiality, and Service Excellence standards.
Support the onboarding of new Case Managers, inform supervisors of issues affecting workflow, and participate in professional development and mental health–related training.
Performs other duties as assigned/required by this position.