Remote Care Manager - Pediatric Behavioral Health

Description and Requirements

The Remote Behavioral Health Pediatric Care Manager plans and manages behavioral and/or physical care with under 21 members and their parents/legal guardians and providers to achieve better health outcomes. The Care Manager facilitates and coordinates behavioral and physical health care to address identified members' needs across the continuum of care. The CM adheres to clinical standards of care for the under 21-member population including but not limited to SED, Developmentally Disabled, Medically Fragile, and foster care populations, through collaboration with guardians, providers and other internal and external partners. The CM will also adhere to departmental and state guidelines for HCBS and State Plan Services and monitor for appropriate outcomes.

• Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
• Conducts assessments to identify barriers and opportunities for intervention.
• Develops care plans that align with the physician's treatment plans and recommends interventions that align with proposed goals.
• Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
• Collaborates with provider doctors, social workers, discharge planners, and community based service providers to coordinate care accordingly.
• Coordinates and facilitates with the multi-disciplinary health care team as necessary in order to ensure care plan goals are achieved and maximize member outcomes.
• Assists in identifying opportunities for alternative care options based on member needs and assessments.
• Evaluates service authorizations to ensure alignment and execution of the member's care and physician treatment plan.
• Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.
• Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate.
• Occasional overtime as necessary.
• Additional duties as assigned.

• NYS RN or LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist
• 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations

• Working knowledge of city and state agencies and practices to include OCFS, OMH, CSE, VFCA, ACS
• Experience with AOT, ACT, and Health Home
• Experience working SED, Developmentally Disabled, Medically Fragile and foster care populations
• Experience working with low-income populations
• Experience working with youth with dual diagnosis of mental health and substance abuse
• Case Management experience
• Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing crisis situations
• Fluency in Spanish, Korean, Mandarin, or Cantonese
• Knowledge of InterQual and LOCADTR
• Experience managing member information in a shared network environment using paperless database modules and archival systems
• Experience and knowledge of the relevant product line
• Relevant work experience preferably as a Care Manager
• Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
• Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
• Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems