CASE MANAGER (BSW)

UHS

About The Position

FHCHS of PR, Inc. 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. Website: https://fhcsaludmental.com/ 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

Education: Bachelor of Psychology, Social Work, Social Sciences, or Biopsychology with minor in Psychology.
Licenses: Not required
Relevant work experience: No experience required
Fully bilingual
Basic computer knowledge
Knowledge in Microsoft Office and Outlook

Responsibilities

Upon answering, staff must identify themselves by name, title, and organization’s name following FHC Behavioral Health Contact Center Standards.
Answer incoming calls within the company’s established time frame, using a clear, pleasant tone and appropriate language.
Shows appropriate communication skills, effective listening, and case management skills to deal with challenging situations.
Provide support to members calling the Behavioral Health Contact Center by conducting needs assessments, brief interventions, facilitating referrals and supportive engagement.
Have immediate access to licensed clinicians or clinical manager or supervisor.
Consult with Behavioral Health Contact Center psychiatrists and/or licensed clinicians whenever necessary.
Escalate clinical concerns to supervisors, other licensed health professionals or clinical managers when outside the scope of practice.
Refers callers to appropriate services, including outpatient therapy, inpatient care, or community-based resources.
Collaborate with emergency services (e.g. 911, mobile crisis units) when immediate intervention is required.
Follows internal protocols for mandatory reporting, including cases involving abuse, neglect, or threats to self/others.
Verifies the member eligibility before processing and registering the phone call in FHC’s platforms.
Educates the member or authorized representative about our programs and coverage’s benefits.
For initial screening, the Case Manager does: a. Structured clinical data acquisition: (Structured clinical data is collected using scripts). b. Conducts telephone interviews to gather the necessary data using structured clinical data (scripts) and Triage Logic platform to logs the health care services, coordinate appointments, make the appropriate referrals, and service authorizations. c. Collection and transfer of clinical and non-clinical data. d. Activities that do not require evaluation or interpretation of clinical information. e. Review of service request for completeness of information.
Maintains the confidentiality of the documents and the information received.
Facilitate access to immediate services if an individual reports risk of suicidal or homicidal ideation or threats.
Provide solution-focused interventions such as helping member practice calming/coping skills, facilitating linkage to ongoing support, and explaining the mental health services available.
Documents according to the requirements of the Health Insurance Portability and Accountability Act (HIPAA) and Law 408.
Carry out delegated duties such as: a. Outbound calls for the purpose of requesting information to verify next appointments, attendance at previous appointments, coordinate services and provide service authorizations number, if applicable. b. Faxing materials c. Mailing/e-mailing already identified materials. d. Follow up with referrals. e. TTY validation. f. Follow up Call Backs.
Comply with the established quality parameters for abandonment rate, average speed of answer, coordination of services and notification, calls classification and routing, and first call resolution.
Interacts with providers, members, and other professionals in charge of member’s care to validate continuity of service.
Manages the emergency calls in coordination with a licensed clinician according to the standard procedures established in the practice of mental health services and according to the internal policies and procedures established by the organization relevant to the Behavioral Health Contact Center.
Validate the registration process of the admissions to mental health services.
Enter the inpatient admission registration to the Registration Hospitalization Module when the facility cannot complete the task.
Assist members and/or providers with the transition of care by identifying resources to support the discharge plan.
Receives and verify referrals for the coordination of appointments.
Provide mental health first aid to members in crisis.
Responsible for calling psychiatric inpatient facilities to validate admissions and discharges.
Responsible for entering information related to admissions and/or discharges in the Web Census platform.
Provide backup to Utilization Review Department out of business hours including document in the appropriate platform services request, provide information of service request status, provide information of operational hours, orient about the appointment of representative process, close previously authorized services and send notifications to providers, among others.