Provides inpatient and intensive outpatient case management for high-risk, high-utilizing members with acute and/or chronic psychiatric conditions across the continuum of care. Develops treatment and care plans for the specific population.
Essential Functions:
- Plans, develops, coordinates, assesses, and evaluates services provided to members to promote quality and cost effective outcomes.
- Develops and maintains case management policies and procedures to assure optimal and appropriate member utilization of services.
- Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/ approvals for outside services.
- Participates in the development of care paths.
- As an Intensive Case Manager coordinates the care of a large caseload of high risk patients and provides assessments and interventions in the community including in-home visits.
- Consults with internal and external physicians, health care providers, discharge planning, and outside agencies regarding continued care/treatment or hospitalization.
- Arranges and monitors follow-up appointments.
- Makes referrals to appropriate community services.
- Identifies and recommends opportunities for cost savings and quality of care improvements across the continuum.
- Develops and collects reports and data, and trends utilization of health care resources.
- Develops and presents in-service training and communication to both internal and external stakeholders.
- Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
- Coordinates the transmission of clinical and benefit information and treatment to patients, families and outside agencies including issuing Non-Coverage and Denial of Benefits letters consistent with Health Plan Regulations.
- Acts as liaison to psychiatry clinics outside agencies, non-plan facilities, and outside providers.
- Coordinates repatriation of patients and monitors their quality of care.
- Provides administrative case management oversight to Inpatient Psychiatric Facilities, Crisis Residential Programs and IMDs to ensure that services delivered to our members meet Kaiser's Quality and Utilization expectations and guidelines.
- Provides administrative on-call to the RSR/Sub-regional Office.
- Provides Clinical and Administrative documentation in accordance with Kaiser Regional Psychiatric Standards including the Inpatient/Integrated Urgent Services Guidelines.
- Travel is required.
Secondary Functions:
- Plans, develops, coordinates, assesses, and evaluates services provided to Autistic children to promote quality and cost effective outcomes.
- As an Intensive Case Manager coordinates the care of a large caseload of autistic patients and provides assessments and interventions in the community including in-home visits and travel to outside vendors and ASD clinics as necessary.
- Consults with internal and external behavioralists and therapy vendors, health care providers, discharge planning and outside agencies regarding continued care/treatment.
Qualifications:
Basic Qualifications:
- Previous experience, usually two (2) years in an inpatient psychiatric setting or psychiatric emergency service.
- Previous experience, usually two (2) years of care management or clinical experience, and responsibility for a large caseload (50-100) for an extended period of time.
- Demonstrated experience in utilization data collection and cost benefit analysis.
- Master's (Social Work or Psychology), or PhD (Psychology) required.
- LCSW, MFT or Psychologist License required.
- Must have a National Provider Identifier (NPI), or obtain an NPI, prior to employment start date.
- Demonstrated expertise in crisis management.
- Knowledge of TJC, and other local, state, and federal regulations.
- Must be able to work in a Labor Partnership Environment.
Preferred Qualifications:
- Minimum 2 years experience working with children and families.
- Would consider SLP or OTR/ L if experience in case management and developmental disabilities.
- Experience mentoring staff and students, resource to peers and other disciplines, teaching in the facility/organization/community.
- CPR (BLS) certified.
- Excellent customer service skills, high mps scores.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.