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General Information


Job title: Behavioral Health Case Manager
Job location: New York, NY 10001 United States
Requisition code: 13-0162
Date posted: 03/06/13
Job type: Full-Time

Job Classification

Job Category:Case Management

Job Description

Job description:


Job Title: Behavioral Health Case Manager

Department: Medical Management

Reports To: Assistant Director, Medical Management

Position Summary:

The Behavioral Health Case Manger plans and manages patient care with members, their families or significant others, and coordinates with the PCP, SCP and all members of the health care team to facilitate the patient's care across continuums of care episodes.

Frequently communicates complex information and interacts via electronic documentation/tools. This is a paperless work environment requiring daily hands-on administration of multiple electronic Patient Health Information (PHI) databases and security requirement tools such as encryption. These systems include, but are not limited to, CCMS (CareEnhance Clinical Management Software), Sunguard Macess Service Module (electronic archiving), RightFax, VoIP, Virtual Work Platforms (using VPN), scanning and creating .pdf files (Adobe Acrobat), and MS Office 2010 software (such as Word and Outlook).

Essential Duties and Responsibilities:

* Performs preadmission, concurrent, and retrospective reviews to evaluate appropriateness of admission, need for continued stay, length of stay, utilization of resources, patient outcomes, and usage of other services post-encounter. Responsible for compliance, in practice, with regulatory mandates.

* Identifies opportunities for and facilitates member transfer to: a) hospital of enrollment/other appropriate in-network hospital when hospitalization occurs out-of-network; or b) hospital of enrollment when hospitalization occurs at another network hospital.

* Evaluates and pre-authorizes request for inpatient/outpatient, specialty care, home care, DME, and transportation services from network and out-of-network providers in accordance with departmental guidelines.

* Functions as a clinical resource/educator for the multi-disciplinary health care team on an ongoing basis in order to maximize quality of patient care as well as effectively manage length of stay and utilization of resources.

* Assists in identifying opportunities for and facilitating alternative care options based on member needs and assessments.

* Assesses member's physical, psychosocial and discharge planning needs through communication with appropriate hospital staff including attending practitioner, utilization review staff, discharge planners, social workers, and coordinates care accordingly.

Other Duties and Responsibilities:

* Assists in emergency call response triage. Conducts telephonic safety assessment and follows protocols for emergency response as needed.

* Contributes to the development of patient-focused care and initiates the process in accordance with established guidelines. Conducts assessments and development of treatment plans as requested. Locates appropriate Social Service resources.

* Documents all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards to ensure integrity of member services provided over the continuum of care and over time.

Qualifications Summary:


Required: Associate's degree.

Licenses, certificates, etc.

Required: State RN License or LCSW.

Work Related Skills and Experience:

Minimum Qualifications:

Technical Skills:

Intermediate Microsoft Word and Excel skills are required. Intermediate experience with corporate email and calendar systems (i.e. Outlook, Lotus Notes) is also required.


* Associate's degree in Nursing or Master's degree in Social Work and a minimum of 3 years of utilization management managed care behavioral health experience in a nursing home, visiting nurse agency, home-based care or HMO organization.

* Will also consider Nursing Diploma and 13+ years of related nursing case management experience that includes at least 3 years of utilization management managed care behavioral health experience in a nursing home, visiting nurse agency, home-based care or HMO organization.


* Experience must include identifying opportunities for alternative care along with demonstrated ability to educate and coordinate resources on an ongoing basis.

* Must have worked with Electronic Medical Records (EMR).

* Good interpersonal and telephone assessment skills essential.

Physical Demands:

While performing the duties of this job, this employee will be occasionally reaching, walking, standing, traveling and lifting/carrying and pushing/pulling 1-10lbs. This employee will also be frequently bending and constantly sitting and keying.

Work Environment:

This employee will constantly be in an indoor environment.

Additional Information:

Candidate trains for approximately 8 weeks our Corporate Headquarters in downtown Manhattan, longer if needed. Then telecommutes from home100% of the time.

Telecommuter requirements:

* Direct Ethernet FIOS or Cable internet connection (wireless connection not permitted).

* Locked file cabinet for secure storage of equipment and paperwork such as job aides (Employee's expense).

This is a paperless environment so there is no printing when working virtually and for the security of patient health information (PHI).

* Separate designated home work area away from the main flow of home traffic.

* No dependent care.

* HF has the right to conduct home site inspection with 24 hours of notice.

* Random work activity audit reports will be conducted for all telecommuting employees analyzing performance and system activity on a given day.

* The employee will be supplied with laptop, head-set for VOIP phone system, blackberry and all necessary applications for business purposes only.

Healthfirst offers a comprehensive benefits package including, but not limited to:

* Medical

* Dental

* Vision

* Basic Life and Accident Insurance

* Supplemental Life insurance

* Dependent Life Insurance

* Short-Term Disability

* Buy-Up Short Term Disability

* Long-Term Disability

* Flexible Reimbursement Accounts

* Healthfirst 401(k) Plan

* Employee Assistance Plan

* Commuter Savings Program

* Eligibility for Annual Bonuses

* Generous Paid Time Off program

* Paid Candidate Referral Program

Conditions of Employment: Employee must pass pre-employment screening which includes a background check and drug testing. Employee must present documentation to verify minimum of high school educational requirement.

Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, disability or veteran status.



Job Requirements

Education, training, experience:
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