Case Manager - Maternal Behavioral Health

Blue Cross Blue Shield of North Carolina

Blue Cross Blue Shield of North Carolina

North Carolina, USA · Remote
Posted on Friday, June 7, 2024

Job Description

Dependent on clinical discipline, the Maternal Mental Health Case Manager coordinates the care and services of behavioral and maternal health member populations across the continuum of care, promotes effective utilization and monitoring of maternal and behavioral health care resources, and assumes a collaborative role with all members of the maternal-behavioral health care team to achieve optimal clinical and resource outcomes.

What You'll Do

-Serve as a team member on a multidisciplinary team that monitors utilization patterns; identifies and facilitates appropriate behavioral health care service delivery for selected members, providers, procedures, and/or diagnoses; and improves the quality and cost efficiency of care and service.

-Application of specific knowledge and clinical skills in maternal and behavioral health care.

-Outreach to members identified as high risk, high cost, or high utilization cases.

-Encourage pro-active intervention to limit expense and encourage positive outcomes.

-Perform a comprehensive assessment of the member’s behavioral health status, educational, and level of support needs.

-Develop a member-centric care plan which includes a self-management plan tailored to member’s needs, and identification of barriers to meeting goals or plan of care.

-Utilize community resources and funding sources in the development of the plan of care.

-Perform ongoing monitoring and management of member including: scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.

-Evaluate and facilitate care provided to members through the continuum of care (office-based, outpatient, inpatient, and residential behavioral health settings).

-Review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.

-May evaluate medical necessity and appropriateness of services as defined by department.

-Document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.

-Complete all correspondence related to case management, including all calls and faxes with phone and fax numbers noted. Obtain consents as indicated.

What You'll Bring (Hiring Requirements)

• LCSW, LPC, LMFT, RN or BSN with 3 years of clinical and/or case management experience in maternal and behavioral health.
• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
• For this role, applicant must be either PSI certified (preferred), or willing to become PSI certified within 6 months from date of hire.

Salary Range

$61,900.00 - $99,000.00