Resp & Qualifications

PURPOSE: 
This position will support our Behavioral Health Care Management team, providing care coordination for Medicare Advantage enrollees. Under minimal supervision, the Behavioral Health Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Behavioral Health. Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes. The ideal candidate will have experience providing behavioral health, including substance use disorders, care management services for people with Medicare insurance and/or geriatric populations. We are looking for an experienced clinician to work remotely from within the Greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

ESSENTIAL FUNCTIONS:

• Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with member, family and providers to develop a comprehensive plan of care to address the member's needs at various stages along the care continuum. Identifies relevant CareFirst and community resources and facilitates program, network, and community referrals.
• Collaborates with member and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member's medical, behavioral and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies to facilitate care between settings. Monitors, evaluates, and updates plan of care over time focused on member's stabilization and ability to self-manage. Ensures member data is documented according to CareFirst application protocol and regulatory standards.

QUALIFICATIONS:

Education Level: Masters degree in Mental Health field required; education can be in one or more of the following areas: Social Work, Psychology or Counseling. 

Licenses/Certifications:
For Behavioral Health Care Managers, must have the following Education, Experience and License(s): Must be licensed in at least one of the three states and/or jurisdictions shown below and have the ability to meet credentialing requirements for independent professional practice (Masters level licensed behavioral health professional):

• Maryland: LCSW-C or LCMFT or LCPC
• Washington, DC: LICSW or LPC or LMFT
• Virginia: LCSW or LPC or LMFT 

Experience: Minimum 5 years post masters clinical behavioral health/psychiatric experience required. 

Preferred Qualifications:

• Experience providing behavioral health care management for people insured by Medicare.  
• Knowledge of best clinical practices and the behavioral health care ecosystem.
• Solid understanding of behavioral health diagnoses.
• Knowledge of mental health and substance use community resources and providers.
• Knowledge of DSM V or most current diagnostic edition.  

Knowledge, Skills and Abilities (KSAs) 

• Knowledge of clinical standards of care and disease processes.
• Ability to produce accurate and comprehensive work products with minimal direction.
• Ability to triage immediate member health and safety risks.
• Basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits).
• Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members.
• Knowledgeable of available community resources and programs.
• Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint.
• Ability to provide excellent internal and external customer service.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. 

Salary Range: $72,360 - $143,715

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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