Meridian

  • Behavioral Health Clinical Care Coordinator - Cook

    Job Location US-IL-Chicago
    Job ID
    2017-4965
    Category
    Community Care Coordination
    Business Line
    MHP Illinois
  • Overview

    Who we are:

    Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.

     

    We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.

     

    Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.

     

    A Day in the Life of a Behavioral Health Clinical Care Coordinator:

    This position coordinates care for Meridian members in the community.  This position oversees the care for high risk behavioral health populations and provides clinical oversight to a team of Care Coordinators to ensure assessment of member’s clinical and psychosocial status, interdisciplinary team approach, and education of members until self- management is achieved. This position provides first line clinical direction to Care Coordination staff and refers to Care Coordination leadership team when necessary. Individuals in this position demonstrate cultural sensitivity, effective communication and motivational interviewing skills. This position follows established safety protocols in the community setting, as well as established preventive and disease management programs for health promotion and education, while delivering culturally appropriate information regarding the availability of health and community resources that will reduce barriers to care. This position is field based with visits to members, healthcare facilities or to assess field Care Coordinators’ function as needed by Director.

    Responsibilities

    • Manage a caseload of members experiencing acute behavioral and or clinical issues.
    • Maintain caseload compliance with all internal and regulatory requirements, complete timely and accurate Behavioral Health Risk Assessment (face-to-face)
    • Create relationships with members working towards their optimal overall health and well-being
    • Facilitates transition of care process for members transitioning from one setting to another by collaborating with the primary care coordinator and external discharge planner. Completes post hospital discharge follow-up: Medication reconciliation, PCP or specialist follow up appointments
    • Reviews and approve a person-centered care plan for all members in assigned caseload involving the members PCP, family/caregiver, Social Worker/Behavioral Health specialists and other specialists as needed to evaluate the individuals’ needs, goals, and plan of action
    • Reviews and approves Critical Incidents Reports prior to submission and assists with the appropriate follow -up
    • Facilitate ICT meetings with members and their identified support team and maintain strong communication with the members’ care team
    • Capacity to drive self to members’ homes and facilities and must comply with Meridian’s travel and mileage reimbursement policies
    • Discusses challenging cases with Medical Director. Provides recommendations to team regarding nutrition, compliance, and pharmacy as it relates to behavioral health. Educate and provide next steps on behavioral health disease progression, medications associated with disease diagnoses and desired outcomes
    • Identifies cases that require team case conferences with the  UM nurse reviewer, behavioral health, nutrition, pharmacy appropriate managers, and plan physician to develop a care plan
    • Develop and maintain relationships with key individuals in the community and act as an advocate to linkages or referrals to improve health, social, and environmental conditions for members
    • Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure member safety
    • Clinical knowledge to evaluate Community Mental Health programs that are best suited for members needs and develops relationships with providers in order to coordinate care
    • Assemble information concerning member’s clinical background and referral needs, and per referral guidelines provides appropriate clinical information to PCP and specialists
    • Assists members in problem solving potential issues related to the community and in home supports, health care system, such as need for transportation, interpreters, etc.
    • Acts as liaison and member advocate between the member/family, physician and facilities/agencies, assuring they receive the services they desire and are eligible to receive
    • Provides ongoing clinical training and education for all staff and coordinate such training with the Care Coordination Clinical Trainer and leadership
    • Ability to use Medical Home Record, Managed Care Systems, Microsoft Outlook and Excel
    • Consistently demonstrates compliance with HIPPA regulations, professional conduct, and ethical practice
    • Assists with special projects or departmental process improvement efforts, as needed

    Qualifications

    What you can bring to Meridian

     

    • BA/BS degree in social science, social work or related field is required
    • Current license to practice as an LBSW, LMSW, LLMSW, LPC, or LLPC in the designated State is required. Minimum restricted licensure or evidence of progress to independent licensure status is required
    • Master’s degree in Social Work, psychology or counseling related field is preferred
    • One (1) year of supervised social work or counseling experience in a health care setting, working directly with individuals, is required
    • Minimum one (1) year experience in discharge planning, home health care, community health or managed care is required
    • Clinical referral and triage experience is preferred
    • Prior experience with the population is preferred
    • Knowledge of State Specific Mental Health and Substance Abuse regulations
    • Knowledge of managed care
    • Knowledge of case management processes including tools and techniques for identification, stratification and management of high-risk clients
    • Excellent organizational and critical thinking skills
    • Demonstrated mastery of state and Meridian required Inter-Rater reliability
    • Skills developing and managing databases for tracking populations and member caseloads
    • Ability to possess a valid State driver’s license and to travel is required. Must be compliant with State Motor Vehicle laws and must follow the policy that pertains to Driver’s License Requirements as a condition of employment
    • Must be able to relate to and work with ill, disabled, elderly, and emotionally upset members
    • Ability to make independent decisions when circumstances warrant such action
    • Ability to prioritize and coordinate population and member care needs
    • Ability to manage multiple tasks simultaneously and efficiently
    • Ability to work collaboratively and effectively with diverse groups
    • Ability to function as part of an interdisciplinary team

     

    What Meridian can offer you:

     

    • Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • Meridian offers 401k matching that is above the national average.
    • Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
    • Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.

    Equal Opportunity Employer

    #MSTR

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