Field Care Manager, Behavioral Health
About The Position
Join Humana as a Field Care Manager, Behavioral Health supporting the WI Medicaid market. As a Field CM BH, you will assess and evaluate members' needs to support optimal health and wellness. In addition, you will guide members and their families in accessing appropriate behavioral health and community resources and facilitate care coordination and engagement across the continuum. You will also work to close HEDIS measure gaps through proactive outreach, education, and coordination with providers and members to improve quality outcomes and ensure compliance with care standards. Perform all responsibilities according to the DHS contract for Medicaid Managed Care Organizations, specifically regarding the Wisconsin Interdisciplinary Care Team (WICT). Identify the appropriate treatment needs, level of service and referral sources for members with medical, psychiatric, and substance abuse diagnoses and facilitate their implementation. Conduct visits in the community to complete monthly face-to-face requirements, including health risk assessments, with identified members and help develop care plans appropriate to the identified treatment goals. Coordinate necessary services with ancillary providers and community agencies to ensure member stabilization within the community. Meet weekly with the iCare interdisciplinary team to collaborate and provide updates on the entire WICT caseload. Contribute to the development of department strategy and refinement of programs, policies, procedures, and quality improvement (QI) projects. Serve as a consultative resource for other care management staff. Educate members on preventive health guidelines and programs including HEDIS gap closures. Lead special projects. Use your skills to make an impact.
Requirements
- Master's degree.
- Applicable WI State licensure as a Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC).
- 2 years of case management experience.
- Must reside in Wisconsin in the Milwaukee or Madison metro areas.
- Valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
- Minimum download speed of 25 Mbps and an upload speed of 10 Mbps for internet service.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Nice To Haves
- Bilingual in English/Spanish.
- Previous experience working in a Managed Care Organization.
- Previous experience with Medicare & Medicaid recipients.
Responsibilities
- Assess and evaluate members' needs to support optimal health and wellness.
- Guide members and their families in accessing appropriate behavioral health and community resources.
- Facilitate care coordination and engagement across the continuum.
- Close HEDIS measure gaps through proactive outreach, education, and coordination with providers and members.
- Perform all responsibilities according to the DHS contract for Medicaid Managed Care Organizations, specifically regarding the Wisconsin Interdisciplinary Care Team (WICT).
- Identify appropriate treatment needs, level of service, and referral sources for members with medical, psychiatric, and substance abuse diagnoses and facilitate their implementation.
- Conduct monthly face-to-face visits in the community, including health risk assessments, with identified members.
- Develop care plans appropriate to identified treatment goals.
- Coordinate necessary services with ancillary providers and community agencies to ensure member stabilization within the community.
- Meet weekly with the iCare interdisciplinary team to collaborate and provide updates on the entire WICT caseload.
- Contribute to the development of department strategy and refinement of programs, policies, procedures, and quality improvement (QI) projects.
- Serve as a consultative resource for other care management staff.
- Educate members on preventive health guidelines and programs including HEDIS gap closures.
- Lead special projects.
Benefits
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- Short-term disability
- Long-term disability
- Life insurance
- Mileage reimbursement is provided for work-related travel.
- Telephone equipment appropriate to meet the requirements for their position/job will be provided.
- Bonus incentive plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
