The Case Manager is responsible for providing case management and support activities for New Directions’ members who have been: discharged from inpatient or residential treatment settings, need assistance during a signification treatment transitions, or have co-occurring medical and behavioral health conditions and who meet the NDBH eligibility criteria for integrated case management. This includes significant coordination with all departments within New Directions, health plans, facilities and providers to promote effective, efficient and quality care for NDBH members.
- Utilizes the components of the case management process i.e., elements of comprehensive assessment, identification of targeted barriers to improvement, linking to needed professional and community resources, development of care plan, implementation of care plan, documentation of outcomes, iterative care plan review and adjustment based on outcomes, health stabilization, and patient graduation
- Promotes and provides quality service delivery and effective care transitions planning for optimal member health outcomes
- Uses motivational interviewing to engage and maintain relationships with members
- Conducts telephonic assessments with the members to gather information regarding the member’s current treatment, possible treatment needs and identify any barriers to accessing services
- Conducts on-site and telephonic communication with the member and/or member’s parents/guardian, facility, and outpatient providers, including primary care physician (PCP) to gather information to identify discharge needs and any barriers to accessing post hospital discharge services and facilitate coordination of services
- Develops goals and objectives with the collaboration of the member to promote self-management, avoid readmission and connect the member with timely aftercare services
- Collaborates with member and facilitates coordination and communication between member and their providers and support system to create crisis prevention plan
- Assists the member to engage successfully with their behavioral providers and others in their support system to move toward self-management
- Facilitates coordination, communication and collaboration on behalf of the member to achieve goals
- Builds trusting collaborative relationships
- Demonstrates case management expertise in response to a variety of circumstances ranging from crisis intervention to routine business matters
- Coordinates with Health Plan medical management and medical services providers, including primary care physicians and patient centered medical homes, to promote integrated member health care
- Participates in clinical staffing and other meetings and trainings upon management request
- Presents clinical cases to staff and consulting providers upon request of supervisor and as required by case management, policies, and procedures
- Utilizes appropriate tools such as NDBH approved case management models, assessment instruments, practice guidelines, and other applications and tools
- Completes appropriate documentation in clinical systems in compliance with regulatory and accreditation standards
- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and New Directions services, policies and procedures and criteria
- Coordinates consultations with member’s provider, family and NDBH Physician consultants on clinical cases when necessary and appropriate to facilitate care and progress
- Stays current with case management technology, member BH benefits, and non-health community resources
- Provides follow-up and support calls to members and providers as needed and as assigned by Manager/Supervisor
- Makes recommendations of programs and/or systems that create improved outcomes and timeliness of the case management department
- Contributes to site specific audits/surveys/research projects that are relevant to case management process, policies, and procedures
- Participates in on-going continuing education as required by professional licensure, certification, or as requested by New Directions and maintains clinical licensure and certifications
EDUCATION & EXPERIENCE REQUIRED
- Has a current, unrestricted state license issued by a state or territory of the United States to practice independently as a Clinical Social Worker, Marriage and Family Therapist, Professional Counselor, Clinical Psychologist or Registered Nurse in the state in which the business operation is located and/or other states as required by law, regulation or contract.
- Minimum of 3-5 years of direct clinical care experience with patients in facility-based and/or outpatient psychiatric or chemical dependency treatment
- Strong clinical and case management skills
- Excellent verbal and written communication and interpersonal skills
- Strong computer and keyboarding skills (Microsoft Outlook and Word), including the ability to document while simultaneously while taking information over the phone
- Ability to comprehend medical policy and criteria to clearly articulate health information
- Valid driver’s license and proof of insurance mandatory for positions which require driving.
- Minimum of five (5) years post-licensure experience in direct clinical care with patients in facility-based and/or outpatient psychiatric or chemical dependence treatment
- For Registered Nurses, a Bachelor’s Degree in Nursing
- Previous experience in Case Management or Disease Management
- Knowledge & ability to apply case management principles and concepts to their case management practice
- Certified Case Managers (CCM) are preferred or ability to obtain CCM within 4 years of hire
- Experience and training in Motivational Interviewing or Health Coaching
- Strong computer skills (Microsoft Office Suite)
Bachelors or better in Nursing.
Masters or better in Clinical Psychology.
Masters or better in Counseling Psychology.
Masters or better in Psychology.
Masters or better in Social Work.
Licenses & Certifications
Lic CL Addiction Coun.
Lic CL Marry/Family Ther
Lic Profess. Counselor