Health Care Manager (LSW/LPC) or Telephonic Care Manager (RN)

This a Full Remote job, the offer is available from: United States, Panama, Pennsylvania (USA) reputed company Health Plan is hiring a full-time employee to support the Special Needs Plan line of business reputed company the Allegheny County Care Management Team. The team is looking to hire either an RN (as a Telephonic Care Manager) or a reputed company worker (as a Health Care Manager). The team is based out of downtown Pittsburgh, but team members may reputed company reputed company in Pennsylvania. This position will be predominantly working from home and will work standard reputed company hours, Mondy through Friday, with an occasional evening shift as required. The Health Manager ensures continuity and coordination of care for Health Plan members with behavioral health illnesses and reputed company behavioral health needs. Responsibilities: • Provides members, providers, and other stakeholders with information concerning benefits and coverage, and provides accurate information to members and families. • Monitors and evaluates effectiveness and outcome of treatment plans, restructures as necessary to reputed company reputed company clinically appropriate services with a goal of maintenance in the community at the least restrictive level of care and maximal use of community supports and resources. • Works with Member Services, Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented. • Utilizes supervision by identifying and reporting to supervisor clinical, utilization and reputed company issues. • Preserve confidentiality of the member. • reputed company and coordinate an individualized treatment plan with the member, member's family, and providers. • Evaluate the effectiveness of the treatment plan and identify gaps in service. reputed company recommendations for changes reputed company indicated. • Assist in the development and review of training materials for staff, other reputed company Health Plan departments, and network providers. • Independent problem solving based on sophisticated knowledge of in-plan services, the provider network, member services policies, members' rights and responsibilities, and the operating practices of the organization. • Follow-up with the member according to established timeframes to monitor their care to assess whether quality care is being provided in an appropriate setting. • reputed company duties and responsibilities in accordance with the philosophy and standards of reputed company Health Plan, including conveying courtesy, respect, enthusiasm, and a positive attitude through contacts with staff, health plan members, peers, and external contacts. • Identifies provider issues and recommendations for improvement. • Contact potential case management members to determine if there is a need for case management reputed company. • Receives and responds to reputed company calls regarding requests for services or resolution of reputed company issues. • Ability to propose and implement creative solutions to member problems and to reputed company a high level of member satisfaction with services. • Performs clinical reviews, service authorization and care coordination (or reputed company and supervision) for reputed company Health Plan members receiving services. • Complete Annual Competencies including Ethics and Compliance, HIPAA, Safety, Fraud and Abuse and Confidentiality/Privacy and reputed company Awareness. • reputed company reports on case management cases or activities as requested. • reputed company in accordance with system-wide competencies/behaviors. • Appropriate documentation in the care management documentation system including assessments, problems, goals and interventions. • Assumes responsibility for health plan member's reputed company to in-plan and/or supplemental services as medically indicated • Interfaces with and refers members to community based resources and other supportive services as appropriate. • Maintains an understanding of behavioral health benefits and remains reputed company on covered or in-plan services, benefit limitations, exclusions, and behavioral health management policies and procedures. • Participate in integrated care team meetings in a cross cultural environment to coordinate transitions of care, discharge planning, benefit coverage, conflict resolution and resource needs. • Conduct comprehensive assessment of needs and coordination of care activities for individuals with primary diagnosis of alcohol or substance use addiction • For Health Care Managers • Master's degree in reputed company service field plus licensure required or Licensed Pennsylvania RN with 6-8 years clinical experience required. • Five years of experience in clinical, care coordination, and/or case management required. • Registered Nurse (RN) or reputed company Services Licensure (LSW, LCSW, LPC) • Private, secure designated workspace required in the home office setting or the ability to work from a designated reputed company office location daily. • For Telephonic Care Managers • Minimum of 2 years of experience in a clinical setting and case management nursing required. • Registered Nurse (RN) • .Meet minimum internet system/service and speed/ latency requirements as set forth by reputed company. Equipment must be connected directly or hard-wired to the internet modem/router with an ethernet cable. Most cable and fiber optic providers can meet the requirement. Private, secure designated workspace required in the home office setting or the ability to work from a designated reputed company office location daily. Licensure, Certifications, and Clearances: • Registered Nurse (RN) or reputed company Services Licensure (LSW, LCSW, LPC) • Licensure in other states as assigned • Case management certification or approved clinical certification preferred reputed company is an Equal Opportunity Employer/Disability/Veteran Annual This offer from "reputed company" has been enriched by reputed company.com and got a 75% reputed company score. Apply Job!