CASE MANAGER (BSW)

UHS • Guaynabo

119d

About The Position

The Case Manager supports the Call Center team in responding 24/7 to individuals in need of services, orientation and/or crisis by providing case management and referring clients 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 for a variety of program services based on member’s needs and benefits under the health plan. The goal of the services provided is to support client 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 clients, 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 clients, in accordance with the timeframes established in the organization's policies. This role also ensures the accessibility and care of the clients.

Requirements

• Bachelor of Psychology, Social Work, Social Sciences, or Biopsychology with minor in Psychology.
• Valid and current active license for Social Work.
• Professional associating membership (colegiación).
• Comply with continuing education hours as they correspond to the specialty.
• Two or more years of experience in the health field.
• Fully bilingual.
• Knowledge in Microsoft Office.

Responsibilities

• Identify themselves by name, title, and organization’s name upon answering the telephone.
• Answer the telephone in the company’s established time frame, with a clear and pleasant tone of voice.
• Show appropriate communication skills, effective listening, and case management skills to deal with challenging situations.
• Provide phone support to members calling the Call Center to conduct needs assessments, brief interventions, facilitating referrals and supportive engagement.
• Verify member eligibility before processing and registering the phone call in FHC’s platforms.
• Educate the member about our programs and coverage’s benefits.
• Conduct structured clinical data acquisition using scripts.
• Conduct telephone interviews to gather necessary data and log health care services.
• Demonstrate knowledge when using the program to log health care services and other technological applications.
• Perform review of service request for completeness of information.
• Maintain confidentiality of documents and information received.
• Facilitate access to immediate services for individuals reporting risk of suicidal or homicidal ideation.
• Provide solution-focused interventions to help clients practice calming/coping skills.
• Conduct interviews and document according to HIPAA and law 408 requirements.
• Consult with Call Center psychiatrists and/or licensed clinicians whenever necessary.
• Comply with guidelines and established criteria for different processes.
• Carry out delegated duties such as outbound calls for medical/clinical record requests.
• Fax, mail, or email identified materials as needed.
• Follow up on initiative referrals and TTY validation.
• Follow up on call backs and manage administrative discharge of cases.
• Comply with established quality parameters for abandonment rate and first call resolution.
• Interact with providers, clients, and other professionals to guarantee service efficiency.
• Manage emergency calls according to standard procedures.
• Validate the registration process of admissions to mental health services.
• Enter inpatient admission registration into the system when necessary.
• Assist members/providers with transition of care by identifying resources.
• Receive and verify referrals for appointment coordination.
• Timely coordinate care for clients and dependents.
• Contact clients to inform them of scheduled appointments.
• Issue authorizations for coordinated services and inform clients.
• Notify relevant parties of necessary coordinated appointments.
• Provide mental health first aid to members in crisis.
• Call psychiatric inpatient facilities to validate admissions and discharges.
• Enter information related to admissions/discharges in the Web Census platform.
• Provide backup to Utilization Review Department out of business hours.
• Participate in new projects as assigned by the supervisor.
• Participate in mandatory training such as Annual Compliance Plan and URAC guidelines.
• Apply policies and procedures pertinent to the Access Center at FHC.
• Comply with established attendance and punctuality policies.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees