This position is fast-paced with a diverse caseload; responsible for completing authorizations and termination of services in a timely manner, communicating with and assisting county/care system case managers to develop and implementdischarge plans for enrollees when necessary or to locate services, or directly assistenrollees in locating and obtaining behavioral health services. This position acts as the care coordinatorworking with enrollees and their interdisciplinary care team to manage care, maintain community living, and improve the life quality of enrollees.
- Carry a targeted caseload of high-need serious and persistently mentally ill enrollees, children in residential facilities, enrollees with a substance use disorder, and enrollees on the restricted recipient program.
- Work as a team with other qualified South Country Health Alliance staff and county/care system staffto meet behavioral health, medical, and care coordination needs of enrollees.
- Collaborate and share information with the enrollee’s interdisciplinary care team to identify and assist enrollees with benefit or utilization issues through focus reviews and care coordination.
- Assess enrollee wishes, unmet needs, choices, strengths and assets to identify care coordination or case management strategies that will best assist the enrollee’s condition.
- Evaluate individualized care and effectiveness in accordance with standards or protocols for enrollees by developing and carrying out an enrollee-centered care plan.
- Ensure the enrollee’s behavioral health care and care coordination services are comprehensive, community-based, culturally-sensitive, enrollee-centered, high quality and cost effective.
- Serve as a contact point, advocate, and resource for enrollees and providers by assisting to facilitateenrollee access to appropriate services, providers, interdisciplinary care team members and additional resources.
- Serve on committees and task forces as appropriate to contribute to program improvements and education; attend meetings as scheduled related to behavioral health.
- Coordinate efforts to gain member feedback regarding their experience related to benefits and services; participate in interventions which address enrollee articulated needs.
- Identify and communicate with the Director of Health Services, Senior Health Services Manager, or Behavioral Health Program Manager all potential or active quality of care concerns involving member safety. Consult as needed regarding enrollee issues.
- Other duties assigned within the scope, responsibility and requirements of the job.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above and below are representative of the knowledge, skill, and/or ability required.
Must be able to read and write in English and have excellent verbal and written communication skills.Knowledge of Spanish preferred.
Analytic skills required.
High level of confidentiality and attention to detail is required due to the subject matter of the work. Work is not regularly checked; impact of errors or negligence would cause significant loss, waste of time and/or materials or significantly affect enrollee’s ability to access services or relationships with business partners.
Requires use of considerable judgment and broad decision making, complex problem solving (technically and administratively);Must understand cause and effect relationships and be able to draw conclusions from data, regulatory requirements, and past practices.
The physical demands described represent those that must be met by an employee to successfully perform the essential functions of this job. Where possible, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit, stand and drive and; use hands to navigate office equipment (i.e. computer, telephone) and use office supplies; and reach with hands and arms.
The employee may occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.
The duties of this job require the employee to be seated at a computer approximately 75% of the time. Communication by telephone is an integral part of this position.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee should encounter no unusual or hazardous conditions. The noise level in the work environment is usually low.
Must be able to travel in-state to counties, Minnesota DHS, and providers within our service area for meetings and trainings an average of 1-2 days per month.
Maintains satisfactory relationships; may include collaboration in executing established policies, discussion of ways to reach agreed-upon objectives, securing compliance with approved procedures.
Moderate monetary responsibility and risk. This position is responsible for ensuring that South Country Health Alliance is following contract language as promulgated by governmental agencies. Failure to comply with this contractual language could result in breach of contract resulting in a moderate financial penalty, potential contract cancellation, sanctions and/or corrective action.