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Function as a primary contact for members with Opioid Use Disorder (OUD)/Behavioral Health with co-morbid medical conditions including pregnancy to provide intensive case management interventions.
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Identify resources needed for a fully integrated care coordination approach including facilitating referrals to special programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.
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This job provides telephonic integrated behavioral and physical health case and condition management services to members with mental health, substance use, and co-morbid chronic medical conditions.
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5 years of Post licensure experience in any combination of behavioral health clinical, case management and/or condition management. Certified Case Manager+ CAC - Certified Addiction Counselor.
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Behavioral health conditions include serious mental illness, untreated mental health, alcohol use, and opioid use. Master's Degree if Licensed Behavioral Health Professional or Licensed Social Work.
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Participate in ongoing training and educational activities related to behavioral health and medical topics. The incumbent uses clinical and motivational interviewing skills to assess both behavioral and physical health needs, and social determinants of health to establish mutually agreeable short and long-term health goals.
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Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
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Conduct clinical and psycho-social assessments telephonically or in the community that address the health and wellness needs of the Organization's members. + Utilize standard case management approach to manage members' conditions (Motivational interviewing; Develop plans of care; Establish a plan for contact to review progress/assess needs; Communicate with treating provider(s); Identify community-based resources for long-term maintenance.
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The overall goal is to help members navigate the health care system and develop condition self-management skills through behavior change. This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
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Assess for social determinants of health and link members with community resources to eliminate barriers. + Collaborate with case and condition management teams to provide co-management activities for members who require additional services.
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Provide members with resources and tools to assist in health-related decision making. One of the following:+ Registered Nurse (RN)+ Licensed Professional Counselor (LPC)+ Licensed Clinical Social Worker (LCSW)+ Licensed Social Worker (LSW)+ Licensed Marriage and Family Therapist (LMFT.
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7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals.
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For assigned case load, create care plans to address members' identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment.
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Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law.
$57,700 - $106,700 a yearFull-timeRemoteExpandApply NowActive JobUpdated 29 days ago
behavioral health case manager jobs Company: Highmark Health in Port-st-lucie, Florida
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