Senior Care Manager

Glen Allen, VA

Post Date: 06/14/2017 Job ID: 19826 Category: Registered Nurse

  • 8 hr. Shift between 8am 6pm.

Job Summary:
  • The Case Management Integration Specialist (CMIS) will provide support for members who are at risk for significant behavioral events or have severe and/or chronic behavioral/or other co-morbid medical health conditions including poly-pharmacy.
  • CMIS staff is responsible for coordinating behavioral health services to medically compromised members, as well as, education and training to the customer s medical case management team.
  • These specialists will direct and manage medically complex members cases based on established member selection criteria, interventions, and program policies and procedures.
  • The CMIS ensures coordination of services for members with other programs, behavioral health providers, and primary care physicians (PCPs); contributes to overall management of healthcare costs, including behavioral health, through proper application of Medical Necessity Criteria (MNC) and minimizing unnecessary ER visits, potential medication interactions and hospitalization.
  • Their primary goal is to ensure behavioral health support to influence behavioral changes which ultimately result in improved member well-being.

Essential Functions:
  • Serves as consultant to the customer medical case management teams in identifying behavioral health conditions and treatment options for medically complex cases.
  • Collaborates with other MHS clinical specialty services (i.E., Conditioned Care Management, Enhanced Medical, etc.) to maximize outcomes.
  • Administers survey screenings and identifies interventions for members, family members, providers, and PCPs to improve member s ability and/or motivation to self-manage their conditions including education around coordination of medications for both behavioral and medical conditions.
  • Educates and informs members of treatment options, as well as collaborating with PCPs, Providers, Family Members, and other managed care coordinators to articulate interventions and ensure optimal levels of functional status and wellness.
  • Establishes individualized, measurable plans of treatment in collaboration with members and health plan case managers that address issues such as quality of life, satisfaction with care, functional abilities, effectiveness of treatment and barriers to goal attainment.
  • Identifies and diagnoses medical and behavioral symptoms of members, as well as applies knowledge of potential contraindications and side effects of prescription medication in the development of member treatment plans.
  • Receives inbound and make outreach calls to members in order to ensure appropriate delivery and access to services.
  • Assists in the coordination of medical and behavioral services in complex cases taking into account medical co-morbidities.
  • Identifies and removes barriers to accessing services and assists members as needed.
  • Follows established behavioral health disease management guidelines specific to conditions management program with respect to documentation and maintenance of care plans.
  • Monitors patient and family response and compliance with the care plan.
  • Participates in meetings and consults with Physician Advisor/Medical Director on regular basis concerning the progress of members.
  • Provides consultation to PCP/Provider as indicated with consent of member.

  • MUST have excellent customer service skills as he/she will be member focused and working with a treatment team.
  • At least 5 years of experience in, or in combination of public sector, community service boards, hospital setting and or who's familiar with the Medicaid population.
  • One of the following licenses are required: LCSW, LCPC or LMFC.

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