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*Behavioral Health Case Manager (Tampa, FL)-1405818

IBM Type Full time Posted 4/23/2014
Salary - n/a - Starts - n/a -
FL - Florida (All) - Tampa Referral - n/a -    
Job Description 
*Behavioral Health Case Manager (Tampa, FL)-1401346
About WellCare: WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled, as well as prescription drug plans. The company serves approximately 3.3 million members nationwide as of January 1, 2014. The company employs more than 5,100 nationwide. For more information about WellCare, please visit the company's website at www.wellcare.com. A Fortune 500 company traded on the New York Stock Exchange (symbol: WCG).

EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.
Provides behavioral health care management services through prospective, concurrent and retrospective evaluation and review of treatment.  Determines medical necessity, level of care required and quality of care provided.  Coordinates and manages behavioral health services rendered by network and non-network providers to health plan members using InterQual criteria, clinical skills and expertise, persuasive communication and access to care standards to promote cost-effective quality outcomes.  Oversees and coordinates all facets of care management including initial contacts, necessary triage, pre-certification, administrative and clinical concurrent review, discharge and aftercare planning/referrals and linkage of patients to appropriate mental health providers and outside agencies for follow-up care.
Essential Functions:
• Performs behavioral health triage and crisis management services.  Links and coordinates services with medical/surgical departments and other outside agencies, such as transportation and home health care.  Coordinates psychiatric diagnoses, behavioral health treatment services, and psychotropic medications with behavioral health providers and physician advisors.  Refers members to the appropriate level care and reviews and authorizes care services using InterQual criteria and medical necessity guidelines.  Documents treatment authorizations and monitors, tracks and reports behavioral health care utilization.
• Conducts all necessary direct utilization management activities for behavioral health plan members including service coordination for members in crisis, crisis intervention, behavioral health triage, crisis assessment services, pre-certification and authorization of care for both psychiatric and chemical dependency services, all necessary concurrent review with hospitals and mental health centers, discharge and aftercare planning and referrals for continued outpatient care.
• Interacts on a daily basis with hospital representatives and attending psychiatrists and coordinates physician-to-physician reviews with the medical director.  Reviews treatment plans and consults with medical director regarding medical necessity criteria for continued inpatient stay.  Facilitates community placements, agency linkages and coordinates discharge planning, aftercare, referral and follow-up of inpatients. 
• Documents, monitors, tracks, and reports authorizations, denials, treatment plans, clinical findings, progress notes, and case dispositions related to behavioral health services using automated and manual systems and formats.  
• Monitors, tracks and reports cases. Monitors utilization trends by hospital and attending psychiatrist with emphasis on managing high volume providers.
• Identifies high risk/high volume members for more intensive follow-up care and conducts hand-off coordination between Clinical Coordinators and providers.
• Coordinates community resources with emphasis on the development of natural support system.  Coordinates benefits, regulations, laws and public entitlement programs.  Applies psychological and counseling theory and industry standard clinical guidelines with the appropriate ICD-9/DSM IV diagnosis.  Maintains HIPAA standards and confidentiality of protected health information.  Reports critical incidents and information regarding abuse and neglect.
• Ensures members have access, availability and quality care according to standards.
• Participates in case conferences regarding high risk/high volume regarding provider and hospital issues. Attends and participates in other HBH work groups and meetings as required.
• Responds to incoming telephone calls as assigned, meeting or exceeding the standards for phone access and availability in order to meet the needs of members served by the department.
• Performs all other clinical and administrative duties as assigned.
Education:  Bachelor's degree RN or Master's Degree (M.S. or M.A.) with major in clinical social work, psychology, counseling, rehabilitation etc.   
2-3 years experience in a clinical/hospital setting using stated criteria
1+ year clinical behavioral health experience providing direct patient care services.
Experience providing care management or utilization management services in a managed behavioral health organization, community mental health center, health plan or hospital preferred.
Knowledgeable of and comply with state and federal statutes, rules and policies that affect the members.
Licenses/Certifications:  Current FL  licensure as a Registered Nurse (RN), or Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT).   
Special Skills (e.g. 2nd language): 
Ability to communicate on any level required to meet the demands of the position.
Ability to review and interpret treatment plans.
Ability to define problems, collect and interpret data, establish facts, draw valid conclusions and process work to completion.
Bi-lingual (Spanish and English) capabilities in reading, writing and speaking preferred.
Ability to correctly (spelling and grammar) write business letters and comprehensive reports.
Ability to effectively present information and respond to questions from families, members, and providers.
Ability to provide crisis intervention services to members under the supervision of the medical director.

Primary Location


Is a relocation package available?