Behavioral Health, RN Case Manager
Steward Health Care Network
Steward Health Care Network
Position Purpose: The Behavioral Health RN Case Manager is a core member of Steward's collaborative care team and will assist the Primary Care Physician and care team to ensure patients with severe mental illness and/or substance who experience ambulatory medical needs are met in the most efficient, cost- effective manner possible. The Behavioral Health RN Case Manager works closely with the patient's primary care provider and care management team to develop, implement and evaluate a plan of care tailored to the patient's unique needs. The Behavioral Health RN Case Manager provides consultation and assists members in understanding the implications and complexities of their current situation and/or overall medical care.
Essential Duties and Primary Accountabilities:
* Provides telephonic medical consultation to patients with severe mental illness who have high rates of physical and behavioral health utilization
* Ensures the appropriate delivery of services through Assessment and Case/Problem Identification, Coordination, Planning, Monitoring, and Evaluation.
* Reviews comprehensive assessment and care plan completed by the assigned BH Care Manager/CHW and implements medical component in to care plan.
* Assesses, plans, implements, monitors and evaluates options and services to meet complex behavioral health and psychosocial health needs of patients
* Places referrals to external behavioral health and/or substance use community based resources to assist patient in accessing quality and cost effective care (i.e. - medication management, MAT treatment, etc.)
* Coordinates care with internal and external resources to meet identified needs of the patient's care plan and collaborates with providers
* Monitors and evaluates effectiveness of care plan and modifies plan as needed
* Interacts continuously with members, family, physician(s), and other resources to determine appropriate behavioral action needed to address medical needs
* Provides clinical consultation to physicians, professional staff and other teams members/supervisors to provide optimal quality patient care and effective operations
* Identifies patients at high risk for long term/chronic care and collaborates with the Behavioral Health care team to develop and implement suitable life plans.
* Develops criteria to identify ambulatory clients at risk for high cost/chronic care and intervenes to provide a care plan, which utilizes appropriate resources across the continuum.
* Identifies availability of community services for clients who are in need of services that are not skilled.
* Facilitates the delivery of services by establishing relationships with all health care providers, health plans, facilities, and community resources, ensuring appropriate utilization across the continuum of care.
* Serves as the clinical conduit to the patients PCP and ensures patients are engaging with their PCP to complete their care management treatment plan or preventive care services
* Performs Case Management services taking into consideration the client's physical, cultural, social, behavioral health and psychological needs.
* Identifies need for and facilitates the development of ambulatory-based programs to effectively meet the needs of chronically ill and at-risk patients. Coordinates these efforts with SHCN Inpatient Case Management staff.
* Supports SHCN efforts to meet federal and state regulations as well as health plan specific policies and procedures.
* May perform utilization reviews per Interqual Guidelines.
* Participates in committees and meetings at Steward Hospitals and IPAs.
* Provides consultation and education to the client/family and other health care members as needed.
* Participates in Case Management meetings and educational programs sponsored by SHCN Services, Steward Hospitals, and health plans.
* Understands and adheres to all health plan and regulatory guidelines including NCQA/CMS/URAC/ERISA.
* Maintains and respects patient confidentiality according to SHCN HIPAA policy and procedures.
* Maintains documentation standards in conjunction with policy and procedures.
* Provides concise and thorough documentation through psycho/social assessment and progress notes, including changes in medical psycho/social functioning, progression and attainment of goals, referrals to internal and external agencies, and contact/involvement with patient's family
* Demonstrates cultural sensitivity and respect for the patient
* Performs other functions as assigned.
Job Reference #: 53763