FIELD-BASED REMOTE | Behavioral Health Case Worker - Serious Mental Illness (McCormick / Edgefield Counties, SC)

Responsibilities

The Field- Based Remote Behavioral Health Case Worker is responsible for managing and coordinating care, services, and social determinants of health for Members with behavioral health conditions and acute, chronic, and medically complex needs. Serves as the primary point of contact for the care team that includes Members, physicians as well as community supports to guide members in achieving their optimal level of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care, and barriers to care. The Field- Based Remote Behavioral Health Case Worker develops a plan of care through shared decision-making with the Member / caregiver and in collaboration with providers and other care team members to improve the Member’s health status and compliance with treatment plans and promote self-management. The Field- Based Remote Behavioral Health Case Worker is also responsible for the following :

• Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the plan's effectiveness.
• Review the medication list and help members coordinate pharmacy needs with a community pharmacist to ensure medication reconciliation is completed when any changes occur.
• Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the Member / caregiver's progress, needs, and preferences.
• Establishes points of contact in order to collaborate with identified community, medical, and / or behavioral health teams.
• Maintain timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable.
• Monitor appropriate utilization and coordinate services with other payer sources, make appropriate referrals, and identify and escalate quality of care issues.
• Develop a working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements.
• May identify cases to be presented at care management rounds and follow up with providers on recommendations to achieve optimal outcomes for Members.
• Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support our culturally and demographically diverse Member population.
• Conduct Face-to-face visits at the Member’s residence, provider’s office, hospitals, other acute locations, or community locations for education and / or assessment.
• Other duties as assigned.

Education / Experience :

Required travel and willingness to access members' home and community locations within assigned regions. Must possess reliable transportation, a valid driver's license, current auto insurance, and willingness / ability to drive a personally owned vehicle.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k), Tuition reimbursement and more.

Generous paid time off and paid volunteer time off.

Employer-matched 401(k) and additional non-elective contributions, starting on day one.

Medical, dental, and vision plans — with coverage starting on day one.

Employee assistance programs, fitness reimbursements, nutrition counseling, and more.

Employer-paid life insurance, with opportunities to purchase additional coverage.

Employer-paid short-term disability coverage and long-term disability coverage.

Tuition assistance, including reduced tuition at certain schools.

Financial assistance with adoption, including paid time off.

Flexible spending and health savings accounts to pay for qualified expenses.

Discount programs on entertainment, travel, and more.