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Job Title: Case Management Integration Specialist RN - CN8225EN
Job Location: NJ: Newark
Pay Rate: Open
Job Length: full time
Start Date: 2008-09-14

Company Name: Magellan Health Services
Contact: Recruiter
Phone: email only please
Fax: email only please

Description: Case Management Integration Specialist RN - CN8225EN Requisition ID 4078 Full/Part Time Full-time Location

Newark NJ

Description JOB SUMMARY

The Case Management Integration Specialist will be co-located at the customer location all or part of the time and will serve as an integral part of the medical case management team as the behavioral health expert. The Case Management Integration Specialist (CMIS) will provide support for members who are at risk for significant behavioral events or have severe and/or chronic behavioral/medical health conditions. CMIS staff is responsible for coordinating behavioral health services to medically compromised members, as well as, education and training to the customer’s medical case management team. These specialists will direct and manage members’ cases based on established member selection criteria, interventions, and program policies and procedures. The CMIS ensures coordination of services for members with other Magellan programs, behavioral health providers, and primary care physicians (PCPs); contributes to overall management of healthcare costs, including behavioral health, through proper application of Medical Necessity Criteria (MNC) and minimizing unnecessary ER visits and hospitalization. Their primary goal is to ensure behavioral health support to influence behavioral changes which ultimately result in improved member well being.

ESSENTIAL FUNCTIONS

* In collaboration with the respective healthplan case manager, the CMIS:

* Serves as consultant to the customer medical case management teams in identifying behavioral health conditions and treatment options. Collaborates with other MHS clinical specialty services (i.e., Conditioned Care Management, Enhanced Medical, etc.) to maximize outcomes

* Administers survey screenings and identifies interventions for members, family members, providers, and PCPs to improve member’s ability and/or motivation to self-manage their conditions

* Educates and informs members of treatment options, as well as collaborating with PCPs, Providers, Family Members, and other managed care coordinators to articulate interventions and ensure optimal levels of functional status and wellness

* Establishes individualized, measurable plans of treatment in collaboration with members and, health plan case managers that address issues such as quality of life, satisfaction with care, functional abilities, effectiveness of treatment and barriers to goal attainment

* Identifies and diagnoses medical and behavioral symptoms of members, as well as applies knowledge of impacts of prescription medication in the development of member treatment plans

* Receives inbound and make outreach calls to members in order to ensure appropriate delivery and access to services. Assists in the coordination of medical and behavioral services in complex cases

* Identifies and removes barriers to accessing services and assists members as needed

* Follows established behavioral health disease management guidelines specific to conditions management program with respect to documentation and maintenance of care plans

* Monitors patient and family response and compliance with the care plan

* Participates in meetings and consults with Physician Advisor/Medical Director on regular basis concerning the progress of members

* Provides consultation to PCP/Provider as indicated with consent of member

NON-ESSENTIAL FUNCTIONS

* Maintains an active work load in accordance with internal CMIS protocols.

* High visibility position located in the customer’s location. Must be able to work independently. Must be able to present themselves in a professional manner at all times and exhibit tactful, influential communication skills.

* Supports the CMC clinical operations team as needed to meet business needs and performance guarantees,--which includes both clinical needs and operation needs.

* Participates actively in the QI program. This may include data gathering, documentation, and analysis.

* Collaborates with other MHS clinical specialty services (i.e., Conditioned Care Management, Enhanced Medical, etc.) to maximize outcomes.

* Be able and willing to escalate issues to the appropriate party across the organization.

* Works with community agencies as appropriate. Advocates for members to ensure treatment needs are met.

* Interacts with providers in a professional, respectful manner that facilitates the treatment process.

MINIMUM REQUIREMENTS

Education: Associates Degree/Nursing Diploma

Field(s) of study: Requires RN; Prefer BSN or above

Experience: 5-8yrs.

Job Specific: 5 yrs post-degree experience in behavioral health

Strong preference for a nursing background with proficiency in medical Psychiatric care required.

Other: Possesses expertise in behavioral health disease management specific to medical co-morbidity; Ability to identify medical and behavioral symptoms; Ability to identify common misdiagnoses; Possesses an understanding of medical tests performed on members; Knowledge of co-morbid disease risk factors; Proficient in pharmacology; Ability to understand disease inflection points to capitalize on clinical windows of opportunities; Ability to apply treatment objectives/findings from evidence based guidelines; Knowledge of managed care, mental health and substance abuse providers and community resources. Ability to function independently and as a team member; Good organization, time management and communication skills; Possesses the ability to achieve organizational goals through development of effective teams. Familiarity with DSM IV/ICD 10 or most current diagnostic edition.

Computer/Technical Skills: Proficient in using computers, Microsoft Office applications, web, IVR technology, materials, and tools.

Licenses, Certifications, etc.: At minimum must have Nursing license from the appropriate state. Candidate meets Magellan credentialing requirements for independent professional practice (Masters level licensed behavioral health professional).

WORKING ENVIRONMENT

This position could involve sustained periods of sitting and typing. In addition, alternative work hours (between 5:00p.m– 8:00a.m.) may be required.

Please refer to Job code magellanhealth-4078 when responding to this ad.

For FASTEST PROCESSING of your resume, please visit http://www.jobcircle.com/classifieds/1684708.html?source=ng to apply online.

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