This position is responsible to provide care coordination to members via telephonic and/or field based care management to inform and educate them on health care programs to address their personal health needs, engage the member in adherence to personal health goals, respond to inquiries from members, and support the clinical operations department with their provider and member activities
This position will be required to complete member telephone and/or field based health screenings, comprehensive health assessments and care planning duties which may require visits to members’ home and/or facilities to support complex and specialty populations
Requirements
Registered Nurse (RN) with 2 years direct clinical care to the consumer in a clinical setting
unrestricted Licensed Professional Counselor (LPC)
Licensed Master Social Worker (LMSW)
Licensed Clinical Social Worker (LCSW)
Licensed Professional Clinical Counselor (LPCC)
Licensed Independent Social Worker (LISW)
Licensed Mental Health Counselor (LMHC) with 2 years of clinical practice at the independent practice level
Current, valid, unrestricted license in the state of operations (or reciprocity)
For compact licensee changing permanent residence to state of operations, obtain active, unrestricted RN licensure in the state of operations within 90 days of hire
Plus 3 years wellness or managed care experience presenting clinical issues with members/physicians
Experience handling medical management programs and health educations programs in an independent manner
Knowledge of the health and wellness marketplace and employer trends
Verbal and written communication skills including discussing medical needs with members and interfacing with internal staff/management and external vendors and community resources
Analytical experience including medical data analysis
PC proficiency to include Word, Excel, and PowerPoint, database experience and Web based applications
Ability and willingness to travel within assigned territory
3 years clinical experience at the independent practice level for Masters-level Behavioral Health Professionals
Patient education experience
Condition Management experience
Bilingual in English and Spanish
Experience in managing complex or catastrophic cases
Certification in Case Management, Training, Project Management or nationally recognized health care certification