Medical and Behavioral Case Manager

Blue Cross Blue Shield North Dakota•Fargo, ND

1d•Remote

About The Position

The Medical and Behavioral Case Manager is responsible for reviewing cases of members with acute or chronic conditions and collaborating with service providers, the patient and family, and internal resources to establish the most effective treatment plan within the provisions of the policy. This position screens, assesses and develops case recommendations, educates patients and family, coordinates with providers and monitors and documents case(s) on an ongoing basis.

Requirements

A bachelor's degree in social work or related field.
Minimum of 3 years in social work or related experience.
Social Work Licensure (LSW, LICSW) by the North Dakota Board of Social Work.
Advanced clinical expertise with the ability to apply complex clinical judgment in a variety of situations.
Advanced interpersonal communication skills with the ability to engage effectively with members, caregivers, providers, and team members.
Strong decisionâmaking skills with the ability to evaluate information, assess options, and make sound judgments within scope.
Ability to adapt to changing priorities, workflows, and member needs while maintaining effectiveness and professionalism.
Effective collaboration skills with the ability to work seamlessly across teams, departments, and external partners.
Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Responsibilities

Identifies and assesses members with acute or chronic conditions for possible case management (CM) intervention.
Develops, coordinates and monitors a plan of care for members with case management needs and educates both member and health care team of services allowed within the benefit plan.
Develops a case management plan of care by initiating contact with the member/designated representative and their health care provider team after obtaining case management program consent from the member.
Assesses initial and ongoing needs with the member/family, health care team and case manager by completing a thorough assessment of medical records and contact with providers and patient.
Collaborates in identifying appropriate alternatives to the present care and provides assistance with identified needs by collaborating with the member and member’s health care team.
Participates in discharge planning, networking with appropriate outside agencies and making appropriate referrals to alternative resources as needed.
Documents case information and practices per CM policy and procedures and in accordance with CM accreditation standards.
Verifies member benefit eligibility for alternative care for medical necessity and appropriateness and initiates the request for service.
Collaborates with internal and external medical, utilization management and customer services teams as needed in the collaboration and coordination of the member’s care throughout the case management process.

Benefits

Affordable medical, dental and vision coverage accepted throughout the United States
Employer funded Lifestyle Spending Accounts, Health Savings Accounts.
Voluntary employee contributions to Health Savings Accounts and Flexible Spending Accounts
Employer-paid life and disability insurance
401(k) retirement plan with company match and immediate vesting
Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.
Additional company perks
Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
Comprehensive learning and development opportunities and an Educational Assistance Program.
16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
Employee recognition, community initiative events and yearly company outings.
Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
Opportunities to connect through employee committees.