Clinical Case Manager (Full-Time, Days)

Typical pay range: $33.75- $50.62

ST. CHARLES HEALTH SYSTEM

JOB DESCRIPTION

TITLE: Clinical Case Manager

REPORTS TO POSITION: Assistant Behavioral Health Manager

DEPARTMENT: Behavioral Health

DATE LAST REVIEWED: February 12, 2024

OUR VISION: Creating America's healthiest community, together

OUR MISSION: In the spirit of love and compassion, better health, better care, better value

OUR VALUES: Accountability, Caring and Teamwork

DEPARTMENT SUMMARY: The St.

Charles Health System's Inpatient Behavioral Health Departments provide services to the community and region including: Treatment for the Serious and Persistent Mental Illness (SPMI) population, acute mental health crisis requiring hospitalization, and collaboration with the outpatient community at discharge.

POSITION OVERVIEW: The Clinical Case Manager provides therapeutic services and discharge planning in support of Master's Level Therapists in Psychiatric Emergency Services (PES) and Sage View as well as required utilization review; assist with pre-authorizations as appropriate.

Account monitoring for accuracy of charges and determining appropriate payment. Responsible for economic assessments that assist with determining disposition, facilitating care coordination meetings with community stakeholders, and tracking/monitoring patient care metrics. Coordinates warm handoffs with appropriate after care and collaborates with community partners in setting up optimal discharge plans for patients.

Assist with training of new intake staff on insurance and billing requirements. This position does not directly manage any other caregivers.

ESSENTIAL FUNCTIONS AND DUTIES:

Performs patient chart reviews for appropriateness and medical necessity of admissions, continued stays, and supportive services to promote quality care and cost effectiveness while maintaining ongoing insurance contact and providing clinical documentation and reviews to insurance companies as requested for purposes of ongoing authorization of hospital stays.

Assures conformity to the federal and state government health care program requirements, the internal hospital utilization review process, and any third-party payer utilization review processes or managed care processes.

Serves as a resource and provides education to physicians and unit staff on inpatient psychiatric medical necessity criteria and appropriate level of care.

Participates and collaborates with the Utilization Review Committee, as necessary.

Identifies and reports quality of care issues through the EMS system or immediately if indicated, to Risk Management.

Participates in medical necessity denials and appeals processes. Ensures prompt and accurate follow up to ensure resolution and timely billing.

Participates in facilitating patient's and family's learning throughout the continuum of care. Reinforces patient's continued health care through teaching and/or referral to community agency follow-up.

Performs patient assessment of social, economic, emotional, and family situations. Responsible for completion of Economic & Discharge Assessment.

Provides group therapy using a variety of evidenced-based treatment modalities, interventions, and strategies primarily from a lens of DBT, ACT, CBT, Solution-Focused, Motivational Interviewing, or another approved modality.

Evaluates and completes ASAM assessments with designated patients to determine the need for residential substance use treatment. Generates referrals for the ASAM continuum of care placement following 42-CFR federal regulations.

Functions as a member of the Interdisciplinary Treatment Team to assure care is accomplished effectively and efficiently in a cost-effective manner. Both facilitates and participates in clinical care conferencing with community stakeholders.

Provides assessment of Social Determinants of Health and connects patient with resources as appropriate. Coordinates aftercare for patients including arranging therapeutic appointments, medication management, and follow up medical appointments within a timeframe that meets Oregon State healthcare metrics. Awareness, ability, and willingness to work with out-of-area service providers to ensure optimum aftercare resources.

Respects the privacy and protects the confidentiality of patients and family members while maintaining the boundaries of the professional discipline.

Obtains and maintains an Oregon Health Plan-certified Community Partner designation for understanding health coverage options. Helps patients complete eligibility and enrollment forms when necessary.

Maintains knowledge of all state and federal regulations as they apply to the admission, care, and discharge of patients from an inpatient psychiatric facility including all pertinent civil commitment procedures/protocols.

Supports the vision, mission, and values of the organization in all respects.

Supports lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.

Provides and maintains a safe environment for caregivers, patients, and guests.

Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient, and accurate.

Participates in creating a healing environment that supports all aspects of the care environment and the wholeness of each individual patient and caregiver.

Participates in creating intentional relationships and demonstrates focused attitudes and behaviors that enhance the care experience.

Provides a therapeutic presence in service to others by purposefully responding to the needs of patients in a caring way, including introducing oneself and explaining role in patient's care, asking the patient his or her preferred name, sitting with the patient to determine his or her care goals, active listening, and communicating effectively and appropriately through touch, eye contact, etc.

Conducts all activities and documents them with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies and procedures, supporting the organization's corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.

May perform additional duties of similar complexity within the organization, as required or assigned.

EDUCATION

Required: Master's degree in mental health or related field.

Preferred: Mental Health Counseling or Social Work degree.

LICENSURE/CERTIFICATION/REGISTRATION

Required: Valid Oregon driver's license and ability to meet SCHS driving requirements. Ability to become a CADC-Candidate within 30 days of hire date.

Preferred: Licensed with a degree-affiliated Oregon State board or ability to obtain license (e.g., LCSW, LMFT, LPC) within 3 years of hire date.

EXPERIENCE

Required: Familiarity with psychiatric terminology, as well as experience obtaining pre-authorizations, continued review, and billing/claims of mental health accounts.

Preferred: Two years' experience in an inpatient mental health setting.

PERSONAL PROTECTIVE EQUIPMENT

Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.

ADDITIONAL POSITION INFORMATION:

General:

Communication/Interpersonal

Must have excellent oral and written communication skills and ability to interact with a diverse population and professionally represent SCHS.

Ability to effectively interact and communicate with all levels within SCHS and external customers/clients/potential employees.

Strong team working and collaborative skills.

PHYSICAL REQUIREMENTS:

Frequently (50%): Sitting, keyboard operation.

Occasionally (25%): Standing, walking, bending, stooping/kneeling/crouching, climbing stairs, reaching overhead, lifting/carrying/pushing or pulling 1-10 pounds, grasping/squeezing, operation of a motor vehicle, ability to hear whispered speech level.

Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 11-50 pounds.

Exposure to Elemental Factors

Occasionally (25%): Chemical solution for Laboratory Caregivers.

Rarely (10%): Wet/slippery area.

Never (0%): Heat, cold, noise, dust, vibration, chemical solution, uneven surface.

Blood-Borne Pathogen (BBP) Exposure Category

Risk for Exposure to BBP

Schedule Weekly Hours:

40

Caregiver Type:

Regular

Shift:

First Shift (United States of America)

Is Exempt Position?

No

Job Family:

SPECIALIST BEHAVIORAL HEALTH SOCIAL SERVICES

Scheduled Days of the Week:

Variable

Shift Start & End Time:

Days Variable