This is a clinical position designed to work with the health plan to increase the integration of physical and behavioral health care. The Behavioral Health Care Integration Liaison will engage members in the appropriate case management program and provide ongoing telephonic case management. Behavioral Health Care Integration Liaison will receive inbound calls through a phone queue as well as make scheduled outbound case management calls. Provide brief focused interventions as well as intensive case management based on pre-determined criteria for program enrollment. Utilize Motivational Interviewing, Cognitive Skill Building and Behavior Modification skills in working with members to achieve best possible outcomes. Behavioral Health Care Integration Liaison will complete billing procedures for the services provided. The primary goal is to influence behavioral changes which ultimately result in improved member well being.
Manage inbound assessment calls to screen members for program enrollment. Initial intake case management calls are key to stratifying members based upon behavioral health and co-morbid health and risk. Initial assessments lead to the care planning process, care coordination, and enrollment into variable intensity case management program.
Deliver Moderate Tiered Case Management for members meeting specified criteria for program enrollment. These activities will include:
• Assessing member’s current situation and needs, identifying treatment barriers and solutions, and directing and supporting the member to follow up with clinical resources identified,
• Engaging in goal-oriented/solution-focused consultative discussions with the member including education on their condition,
• Identifying barriers to accessing services,
• Care coordination across treating providers, support during transitions in care, coaching and assessment,
• Assist members in navigating the system and connecting them with the most appropriate services and/or providers.
Complex Case Management is the most intensive case management and includes the Behavioral Health Care Integration Liaison to deliver the following activities:
• Assessment of enrollee’s clinical situation, current health status and functioning,
• Treatment planning that addresses clinical and psychosocial needs, and includes setting appropriate short-term and long-term goals,
• Coordination with other care givers, including: Nursing (Medical) Case Management Programs with Health Plans;
• Assure appropriate delivery and access to aftercare services and assist in optimizing social and mental functioning by increasing community tenure,
• Help enhance member’s support system through advocacy, communication and resource management,
• Monitoring of progress within the program through the evaluation of the efficacy of the program and the enrollee’s progress including analysis of outcomes.
Behavioral Health Care Integration Liaison will provide health coaching to members who have chronic medical disease with co-morbid behavioral health conditions. Telephonic health coaching includes;
• Establishes individualized, measurable plans in collaboration with members, and acceptable immediate, short, and long-term goals that address issues such as quality of life, satisfaction with care, functional abilities, effectiveness of treatment and barriers to goal attainment
• Educates and informs members of treatment options, as well as collaborating with PCPs, Providers, Family Members, and other managed care coordinators to articulate interventions and ensure optimal levels of functional status and wellness
• Improve member’s ability and/or motivation to self-manage their conditions
• Identifies and diagnoses medical and behavioral symptoms of members, as well as applies knowledge of impacts of prescription medication in the development of member treatment plans
Provides consultation and communication to PCP and other health care providers and systems as indicated with consent of client.
Accurate and timely billing of case management services provided
Participates in meetings and consults with Physician Advisor/Medical Director on regular basis
Provides consultation to PCP/Provider as indicated with consent of member
Follows case management standards, policies and procedures and monitors the integration and implementation of case management principles and strategies into the service delivery system.
Maintain an active work load in accordance with Magellan’s Care Manager Performance standards; Work with Health Plan, BH provider and PCP offices as appropriate; Participate actively in the QI initiatives. Advocate for the patient to ensure treatment needs are met. Interact with providers in a professional, respectful manner that facilitates the treatment process.