The Field Care Manager, Behavioral Health 2 conducts comprehensive member psychosocial assessments through root cause analysis and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs. Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Assess members to recommend activities and behavioral routines to meet the social and medical needs of members and their families. Provides support and/or intervention and assists members in understanding the implications and complexities of their current medical situation and/or overall personal care.
The Field Care Manager, Behavioral Health 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Assesses, plans, implements, monitors and evaluates options and services to meet complex psychosocial health needs of inpatient and outpatient members. Manages a caseload in compliance with contractual obligations and company standards.
Conducts comprehensive member assessments through root cause analysis based on referred member's needs and benefit plan eligibility, and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs.
Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Works towards achievement of optimal clinical and resource outcomes.
Monitors and evaluates effectiveness of care plan and modifies plan as needed. Supports member access to appropriate quality and cost effective care. Coordinates with internal and external resources to meet identified needs of the member's care plan and collaborates with providers.
Acts as a liaison and member advocate between the member/family, physician and facilities/agencies. Provides clinical consultation to physicians, professional staff and other teams members/supervisors to provide optimal quality patient care and effective operations.
Interacts continuously with members, family, physician(s), and other resources to determine appropriate behavioral action needed to address medical needs. Reviews benefits options, researches community resources, trains/creates behavioral routines and enables members to be active participants in their own healthcare.
Ensures members are engaging with their PCP to complete their care management treatment plan or preventive care services.
Assists in obtaining benefits for members through community resources when benefits are exhausted or not available.
Performs other duties as assigned.
Applicable unencumbered Florida state license in field of study to include:
Master's level independent or non-independent license is required OR an RN with a behavioral health background:
Acute Care Nurse Practitioner (APRN)
Licensed Clinical Social Worker (LCSW)
Willing to consider with extensive background in substance abuse disorder: Licensed Clinical Mental Health Counselor (LCMHC)
Required 2 years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, care management and discharge planning
Required 1 year of experience in current care management as a licensed professional
Required Other Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Preferred Other Experience working knowledge of AHCA and CMS guidelines
Required Bilingual (Spanish & English)
Required Intermediate Electronic Medical Record Documentation
Required Intermediate Microsoft Outlook, Microsoft Word, Microsoft Excel
Other Required Information:
Location: Must reside within reasonable daily commuting distance in South Florida, Broward, Dade, Miami-Dade, and, South Palm Beach Counties.
Hours: Flexible Shift between 8 hours 8:30-6:00 PM
Remote Work: This is considered a Work at Home, Remote position within the following above counties - Must be willing to travel to facilities or offices as needed about 40%, or about 3 times weekly.
Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work
Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)
Possession of a valid driver's license and access to a reliable automobile
This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Associates working in the State of Florida will need ACHA Level II Background clearance.
Intermediate Ability to work independently
Intermediate Ability to multi-task
Intermediate Demonstrated time management and priority setting skills
Intermediate Demonstrated interpersonal/verbal communication skills
Advanced Ability to create, review and interpret treatment plans
Intermediate Ability to effectively present information and respond to questions from families, members, and providers
Intermediate Knowledge of healthcare delivery
Intermediate Knowledge of community, state and federal laws and resources
Intermediate Demonstrated written communication skills
Intermediate Demonstrated customer service skills
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Demonstrated problem solving skills
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours