Health Underwriting Manager jobs in Apple Valley, CA

Description

Job Summary:

The Behavioral Health Care Manager is responsible for working effectively with the Health Homes Program members and Care Teams. The ACSW/LCSW functions as a proactive team member in the integration of Behavioral Health services into the Primary Care setting. This position will provide Care Management Services including but not limited to: outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. Is responsible to be a liaison between the Patient, Primary Care Providers and Behavioral Health Providers. Is responsible for caseload management, assists in the integration of whole-person care with goals towards meaningful data collection and improving the health and well-being of the targeted population. Demonstrates willingness to assist co-workers whenever needed. Maintains good working relationship with all clinic personnel. Provides compassionate quality care to the patients of DAP Health.

Supervisory Responsibilities: N/A

Essential Duties and Responsibilities:

Administrative Functions:

• Caseload Management: Responsible for primarily working with a caseload of HHP Members with behavioral health needs.
• Responsible for utilizing brief behavioral health therapeutic interventions as necessary to improve the Member’s ability to manage their own health.
• Provide formal and informal training and support for HHP Members on behavioral health conditions, including treatments and evidence-base for treatment.
• Responsible for assisting Members with care coordination needs, including, but not limited to, the following:
  • Ensuring completion of the Complex Health Assessment (CHA) for all eligible HHP high-risk Members.
  • Assimilate CHA information into a Shared Care Plan (SCP)/Health Action Plan (HAP)
  • Communicate SCP with member, approved family or caregivers and other members of the care team.
  • Participate in multi-disciplinary care team meetings to share information, update, and inform care plan.
  • Coordinate with internal and external health partners to support Member’s comprehensive care needs.
  • Participate and lead (as necessary) for care transition plan responsibilities.
  • Provide active, on-site support for Members and care team staff.
• Assists patients to follow through in their care plan/wellness goals using both phone and in-person contact.
• Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community.
• Responsible for promoting a collaborative and effective working environment within the organization by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on Member case discussions.
• Provide formal and informal training and support for HHP members on behavioral health conditions, including treatments and evidence-base for treatment.
• In conjunction with the LCSW and/or HHP Operations Manager, the Behavioral Health Care Manager is responsible for providing consultation for the non-licensed members of the team when discussing tasks of a clinical nature.
• Responsible for building and maintaining a positive working relationship with Providers, including, but not limited to, communication via in-person, over the phone, and through digital means such as email and fax.
• Responsible for engaging with Members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the Member and his or her medical/behavioral team, as well as to increase the Member’s sense of control over their whole health.
• Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as by identifying and addressing gaps, and by identifying, developing, and testing new practices for improving the outcomes of the HHP.
• Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.
• Collaborates on Member care issues with other teams, participating in weekly systematic case reviews and ad hoc case reviews, and consults with Nurse Care Manager, Licensed Clinical Social Worker, and/or the Behavioral Health Clinician before taking any action that is clinical in nature.
• Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.
• Participates in staff meetings, trainings, committee meetings, or other activities as needed or as directed by Leadership Team Members.
• Maintains up-to-date documentation and non-billable notes on patients.
• Other duties as assigned.

Clinical Functions:

• Provides quality care to the patients of DAP Health, within the scope of practice outlined by state or federal law.
• Delivers care in accordance with established standards of care and accepted community standards. 
• Understands the organization’s commitment to provide high quality patient care. Promotes a Patient centered environment.

Strategic:

• Develop and implement processes in accordance with vision, goals and objectives for department that are in alignment with organizational strategic plan
• Communicates vision, goals, and objectives within own departments and with other departments, including regular department updates regarding current activities.
• Develops, cultivates and maintains future leaders of the organization and empowers them to lead and succeed.
• Maintains awareness of job responsibilities, challenges, barriers and needs within reporting line.
• Monitors department progress and maintains accountability, recommending, and participating in department and/or personnel evaluation and improvement efforts as necessary.
• Effectively collaborates with other departments to work toward shared goals and common vision.
• Maintains awareness of how department fits into the bigger organizational picture.
• Maintains knowledge of regulatory and oversight requirements and ensures compliance.

Program:

• Maintains awareness of direct report’s systems and processes, and participates in process improvement initiatives, as necessary.
• Representative of DAP Health internally and externally
• Presents and pursues opportunities for further organizational development and growth.
• Acknowledges role in productivity and quality improvement.
• Ensure development and maintenance of department policies and procedures and adheres to appropriate organization-wide implementation processes.

Financial:

• Maintain department-level budgets that adequately balance the financial needs of the department against the needs for fiscal responsibility.

Service:

• Actively supports, promotes, and works to fulfill the Mission, Vision, and core values of DAP Health.
• Embodies DAP Health’s core values- Accountability, Compassion, Integrity, Respect, Commitment, Loyalty, and Excellence.
• Provides excellent internal and external customer service.
• Demonstrates DAP Health’s Standards of Customer Service Behavior:  Compassion, Attitude, Communication, Appearance, Sense of Ownership, and Teamwork.
• Participates in on-going customer service training.
• In every action, seeks to promote DAP Health as a top service organization.
• Contributes to the success of the organization by participating in quality improvement activities.
• Complies with all DAP Health policies and procedures and proactively participates in the implementation of new initiatives.

Safety:

• Ensures compliance with policies and procedures related to safe work practices.
• Uses all appropriate equipment and/or tools to ensure workplace safety. 
• Immediately reports unsafe working conditions.

Privacy/Compliance:

• Maintains privacy and security of all patient, employee, and volunteer information and access to such information. Such information is accessed on a need-to-know basis for business purposes only. 
• Complies with all regulations regarding corporate integrity and security obligations. Reports unethical, fraudulent, or unlawful behavior or activity.
• Upholds strict ethical standards.

Qualifications

Qualifications:

Minimum Qualifications (Education and Experience):

• A master’s degree in social work.
• Associate Clinical Social Worker or Licensed Clinical Social Worker required.
• Previous experience in the medical field and/or in the behavioral health/mental health field, preferred.

Knowledge, Skills and Abilities:

• Understanding of, or ability to learn, behavioral health as associated with chronic medical diseases.
• Understanding of, or ability to learn, biological and physiological nature of mental illness.
• Understanding of, or ability to learn, insurance and basic medical terminology.
• Excellent oral and written communication skills.
• Effective interpersonal skills.
• Bilingual in English/Spanish preferred.