Behavioral Health Case Management Nurse / Job Req 587496071

Description
PRINCIPAL RESPONSIBILITIES:
Under the direct supervision of the Manager, Case and Disease Management, the Behavioral Health (BH) case manaement nurse is responsible for the operational delivery of the plan's Behavioral Health related Case Management and care coordination programs and processes. The Behavioral Health Case Management Nurse will provide Case Management services for health plan members with highly complex medical and mental health conditions where advocacy and coordination are required to help the member reach the optimum functional level and autonomy. This position will ensure that members receive appropriate provider linkage and assist the Behavioral Health ABA Analyst and Behavioral Health triage staff with reviewing assessments and treatment plans submitted by providers for adherence to Behavioral Health Treatment (BHT)/Applied Behavior Analysis (ABA) and Behavioral Health "best practice" guidelines. The BH Case Management Nurse will be working closely with a team comprised of the Complex Case Manager Nurse, a Medical Social Worker and a Health Navigators. This collaborate team approach to Case Management will include key departments at the health plan, including Behavioral Health and Utilization Management which may provide clinical expertise and data on patient utilization patterns, often in real time, to the program. Externally, the position will interact with delegates contracted organizations and providers, health networks, and other stakeholders in a manner that promotes collaborative working relationships.
Principal responsibilities include:

• Perform the primary functions of assessment, planning, facilitation and advocacy through collaboration with the member and other health care resources involved in the member's care.
• Work closely with licensed and unlicensed staff to co-manage the care of complex cases telephonically through regular contact with members, caretakers, healthcare professionals and others involved in the member's care
• Maintains clinical expertise and knowledge of best practices for all relevant clinical areas of BHT/ABA and Behavioral Health including statutory and regulatory requirements.
• Carry a caseload of members individually and co-managed as a team
• Collaborates with, and Provides guidance to, the BH clinical staff on issues related to BHT/ABA, Behavioral Health and physical health services provided to members.
• Collaborates with the other local agencies focused on special needs, mental health and substance use, including Regional Center, Alameda County Behavioral Health (ACBH), and Drug Medi-Cal Organized Delivery System to ensure smooth transitions across the continuum of health care.
• Serves as a Behavioral Health Nursing expert for internal departments, health networks, and contracted providers.
• Reviews activities including progress and barriers towards goals, resolves conflicts or strategizes solutions and adjusts current service plans as needed
• The nurse will be resposnible for triage and all aspects of the Case Management / nursing process, including assessing, diagnosing, planning, implementing, and evaluating care.
• Develop multi-disciplinary care plans with the input of the member and PCP to address identified member issues
• Participate in the ongoing process of a identifying the health plan's members who are most at-risk of poor health outcomes and in need of care management services.
• Participate in Multidisciplinary Care Team Meetings and be able to present complex medical cases
• Work collaboratively with health plan's providers, particularly member's primary care providers and specialist, in order to provide highly coordinated and often specialized care
• Communicate with providers, members, and community resources as necessary, to support the planning, implementation and evaluation of care management programs.
• Complete other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Serve as subject matter expert in Behavioral Health nursing and clinical programs in support of the Triple Aim of improving patient experience of care, health outcomes, and reducing overall cost.
• Communicate and coordinate required services for members with PCP's and specialists.
• Manage, document, and maintain casework in accordance with NCQA guidelines and state regulators.
• Build and maintain effective relationship with designated members and those members' families or caregivers.
• Maintain Case Management records.
• Develop appropriate member care plans and appropriate member assessments.
• Research and develop working relationships with appropriate community resources to service members.
• Provide direction to ancillary team/pod staff members who will provide additional coordination activities for health plan members being case managed.
• Leading and participating in internal and external committees and meetings.
• Complying with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
• Making oral presentations, as requested

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Constant data entry using keyboard and/or mouse.
• Frequent use of telephone headset.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.

Number of Employees Supervised: 0
MINIMUM QUALIFICATIONS:
EDUCATION OR TRAINING EQUIVALENT TO:

• BSN or MSN required.
• Registered Nurse license, active and unrestricted California license is required
• Current CPR and first aid card prior to or within six months of hire is preferred.
• Certification in Case Management (CCM etc.) preferred or willing to become certified within 12 months of hire or a date agreed to by supervisor.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Three years clinical Case Management or Behavioral Health experience in required
• Three years clinical experience direct nursing in Behavioral Health setting is preferred

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• In depth understanding of Behavioral Health standards and clinical care best practices.
• Excellent written and verbal communication skills required.
• Experience with Medi-Cal program, Department of HealthCare Services and Department of Managed HealthCare preferred.
• Ability to use and manipulate reported data to assess department metrics.
• Familiarity with HMO, IPA, and medical group contracting concepts, principles, and practices.
• Experience in use of various computer system software including pharmacy programs, as well as Windows, Word, Excel, Outlook, and PowerPoint.
• Experience in use of Care Management Software applications a plus.

SALARY RANGE $121,730.28 - $182,595.42
The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.