Behavioral Health Case Manager
Are you experienced in Case Management and Behavioral Health? Do you value autonomy, creativity & the ability to effect change?
If so…
We want to speak to you about a career at HMA.
HMA is a Third Party Administrator conveniently located in Bellevue with a dynamic, innovative Health Services department currently staffed by 15 RNs plus 9 other allied health personnel. We are a wholly owned subsidiary of Regence BS, and have been here for over 25 years. HMA serves over 100,000 employee lives on behalf our self-insured group health plans. We offer a generous benefit package, competitive salaries, profit sharing, a friendly welcoming culture and the opportunity to work from home. Here is your chance to work with a vibrant, fun and knowledgeable team of RN’s with diverse clinical backgrounds.
The Behavioral Health Case Manager performs case management for complex behavioral health cases by using the case management process which assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an individual’s behavioral health , substance abuse and co-occurring medical needs, with the goal of coordination of care and connecting them with appropriate resources to help move towards self-dependability using communication and available resources while promoting quality, cost-effective outcomes. **Following a significant period of training in our Bellevue office, the individual in this position has the opportunity to work from home.**
Essential Functions:
- Monitor ongoing management of all assigned cases, including assessing treatment plans and options for maximum quality health outcomes in coordination with hospitals, mental health facilities, residential treatment and other community resources.
- Provide health coaching and education for members around their mental health care needs and services available.
- Identify and initiate negotiations for cost savings, quality care improvements and benefit exceptions when indicated to implement quality, cost-effective care across the continuum.
- Communicating with all involved parties including employer groups, account managers, excess loss carriers and claims department.
- Assist clients in transitioning from inpatient to outpatient services.
- Screen referrals for potential case management, including review of claims for potential catastrophic or high exposure/high dollar claim.
- Evaluating outcomes and cost avoidance/savings data for client reporting.
- Support Case Management team case load as appropriate.
- Other duties as assigned.
Successful Candidate will have:
- Current WA State RN license
- CCM certification preferred.
- 3 to 5 years experience in medical case management in a mental health environment.
- 5 years of nursing experience in a clinical setting
- Behavioral Health payer experience preferred.
- Extensive knowledge of Case Management and Utilization Review processes and of insurance terminology.
- Knowledge of clinical practice for diverse diagnoses also required.
- Exceptional communication, customer service, presentation and interpersonal skills.
- Able to work in a self-directed position involving a high degree of complexity.
- Proficient with personal computer and software (MS Office Suite) with good keyboarding skills and the ability to enter and retrieve data from relevant computer systems.
Healthcare Management Administrators (HMA) believes in delivering superior value to our many self-funded Northwest clients by combining competitive rates with superior service. If you would like to learn more about our organization, please E-mail your resume, cover letter and salary history to recruiter@accesstpa.com. Faxed resumes are welcome at 305/574-0443.
