Kaiser Permanente Case Manager, Behavioral Health - Outpatient Continuing Care, Regional Offices-Garrett in Silver Spring, Maryland
The case manager is experienced in behavioral health and addictions social work. The case manager is responsible for applying specialized care management techniques in the clinical management of intensive, chronic, or complex cases and when an individual (child or adult) experiences barriers to recovery. Works primarily with the Medicaid population of children and adult members to coordinate service delivery, develop patient-centered and goal focused care plans and provides coaching and support to reduce risk and promote health and wellness. Builds collaborative relationships with community providers to facilitate care delivery.
Essential Functions: - Completes assessments by gathering information from the member, family, provider, state and local agencies, and other stakeholders according to department's guidelines and timeframes. - Coordinates care across the care continuum for members receiving behavioral heath and substance abuse services. - Serves as the member's point of contact for accountability. - Develops, implements, monitors and evaluates a comprehensive care plan in collaboration with member, family/caregivers, providers, state and local agencies. - Works as a liaison to arrange and coordinate services with community partners including the Virginia Department of Health, state and local agencies for care coordination, referrals and treatment arrangements which may occur as a KP covered service, carved out service or under a waiver program. - Serves as the primary point of contact for Medicaid Behavioral Health Management. Tracks DMAS reports, coordinates care for carved in/out services. - Serves on the state's Behavioral Health Services Administrator QI Committee and participates in clinical management rounds. - Participates in meetings with behavioral health providers to inform them of case management services and benefits available to the members. - Refer members to the state of Virginia who are transitioning to residential treatment. - Maintains a list of providers, agencies and programs that can benefit the member. These include KP, network, carved out/ excluded services and waiver programs. - Maintain current and accurate documentation of contacts, treatment plans, case notes, referrals and assessments in the electronic health record (HealthConnect). Tracking elements are entered in the Case Module of HealthConnect. - Supports Behavioral Health Quality Assurance Activities including but not limited to meeting HEDIS Targets and reducing Inpatient Readmission rates. - Resolves telephone and written inquiries from members and consultants. - Maintains and updates knowledge of treatment approaches, philosophies and techniques for Mental Health/Behavioral Health diagnostic categories. - Maintains knowledge of current DSM and CPT coding categories. - Collaborates with Behavioral Health Referral Assistants and Manager in maintaining and improving the Network referral process. - Assists Behavior Health Managers with special projects as assigned. - Performs other related job duties as requested by Behavioral Health Department Manager.
Qualifications: Basic Qualifications: Experience - Five (5) years of recent experience (within the past seven (7) years) in behavioral health care required. - Two (2) years of experience (within the past five (5) years) in case management required. - One (1) year of experience and the ability to communicate effectively with consultants, members, and Health Plan/MAPMG providers required. Education - Master's degree in social worker required. License, Certification, Registration - LCSW (NOVA) required. - National Provider Identification (NPI) required. - Certified Case Manager (CCM) by the Commission for Case Manager Certification within one (1) year of hire.
Additional Requirements: - Knowledge of Behavioral Health Case Management theory and techniques required. - Ability to work independently required. - Requires the ability to work as part of a dynamic, professional health care team. - Demonstrated ability to manage multiple priorities required. - Requires an understanding of and ease of use with computer, an intermediate understanding of standard database and spreadsheet software (Excel) as well as Word Processing software (Word). - Requires the ability to handle sensitive and confidential information.
Preferred Qualifications: - Experience in both ambulatory and in-patient setting preferred. - Experience working with dual diagnosed patients preferred. - Experience and working knowledge of Community Service Boards preferred. - Experience with motivational interviewing preferred. - Chronic Care Professional Certification through the Health Science Institute preferred. If applicant does not have the certification, completion of Motivational Interviewing Skill Building Webinar Series through the Health Science Institute is required within six (6)months of hire. - Experience with outpatient behavioral health and substance use disorder preferred.
COMPANY Kaiser PermanenteTITLE Case Manager, Behavioral Health - Outpatient Continuing Care, Regional Offices-GarrettLOCATION Silver Spring, MDREQNUMBER 635999
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.