Company :Highmark Inc.Job Description : 

JOB SUMMARY

This job provides case and condition management services to members with Serious Mental Illness (SMI) and/or SMI / Opioid Use Disorder (OUD) with a co-morbid chronic medical condition. The incumbent uses clinical and motivational interviewing skills to assess members’ needs including social determinants of health and establish mutually agreeable short and long-term goals. Supports members in developing self-management skills and adopting positive behavior changes, identifies and addresses gaps in care, barriers to member’s adherence to standards of evidence-based care, helps members to coordinate their comprehensive healthcare services and navigate the healthcare system, and identifies on-line, telephonic and community-based resources. The overall goal is to help members navigate the health care system and develop condition self-management skills through behavior change.

ESSENTIAL RESPONSIBILITIES

Function as a primary contact for members with Opioid Use Disorder (OUD)/Behavioral Health with co-morbid medical conditions including pregnancy to provide intensive case management interventions. Provide members with resources and tools to assist in health-related decision making. Conduct clinical and psycho-social assessments telephonically or in the community that address the health and wellness needs of the Organization's members.Collaborate with case and condition management teams to provide co-management activities for members who require additional services. Participate in ongoing training and educational activities related to behavioral health and medical topics. Pro-actively incorporate lifestyle improvement and prevention opportunities into member interactions and coaching. Provide education on evidenced based treatment.Utilize standard case management approach to manage members’ conditions (Motivational interviewing; Develop plans of care; Establish a plan for contact to review progress/assess needs; Communicate with treating provider(s); Identify community-based resources for long-term maintenance).Assess for social determinants of health and link members with community resources to eliminate barriers. Collaborate with key community and clinical partners.Other duties as assigned or requested.

EDUCATION

Required

High School Diploma/GED with RN license

OR

Master’s Degree if Licensed Behavioral Health Professional or Licensed Social Work

EXPERIENCE

Required

5 years of Post licensure experience in any combination of behavioral health clinical, case management and/or condition management

Preferred                        

5 years of Advanced training and experience in cognitive behavioral therapy (CBT) and or DBT5 years of Experience working with healthcare needs of populations with SMI and substance use disorders5 years of Experience working with the healthcare needs of diverse populations5 years of Understanding of the drug and alcohol system, harm reduction and community resources5 years of Crisis management5 years of Understanding how SMI, addiction, and medical co-morbidities affects familiesProficiency in a second language

LICENSES or CERTIFICATIONS
 

Required

One of the following:

Registered Nurse (RN)Licensed Professional Counselor (LPC)Licensed Clinical Social Worker (LCSW)Licensed Social Worker (LSW)Licensed Marriage and Family Therapist (LMFT)

Preferred

Certified Case ManagerCAC - Certified Addiction Counselor

SKILLS

Advanced knowledge of motivational interviewing and stages of changeProficiency in utilizing PC-based system application and reporting packages, especially Microsoft Office applicationUnderstanding of confidentiality laws as they pertain to Drug and Alcohol and Behavioral HealthKnowledge of evidenced based practices as it relates to treatment of SMI/OUD/behavioral healthExcellent verbal and written communication skills as well as the ability to manage multiple priorities in a rapidly changing environment

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

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