Case Manager

JOB DESCRIPTION

Location: Alter Behavioral Health
Company: Alter Health Group
Reports to: Clinical Manager

Summary

Alter Management, LLC is currently seeking a full-time Case Manager for our new residential adult facility, Alter Behavioral Health, located in Irvine, CA. This innovative, evidence-based treatment program is specifically designed to treat primary mental health diagnoses including ASD and co-occurring disorders. Our mission is to provide the highest level of personalized care and treatment to every individual seeking support to restore and maintain their highest level of functioning. Our dedicated team of professionals employs a comprehensive, multidimensional approach to create a more well-rounded and personalized experience for each individual seeking treatment.

The Case Manager is a collaborative position that includes direct contact and care coordination with patients, nurses, primary therapists, physicians, caregivers, and the community. This position requires excellent communication, both verbal and written, effective resource coordination, and addressing the individual psychosocial needs of the patient.
The goal of the Case Manager position is to advocate for and assist the patient in the achievement of optimal health, access to care, and appropriate utilization of resources. To meet the patient’s individual healthcare needs this position includes assessment, planning, implementation, coordination, monitoring, and evaluation of the plan of care. Alter Management operates a series of evidence-based treatment centers for adults struggling with mental health issues, particularly ASD, and other co-occurring disorders.

Essential Functions

• Assessment: The Case Manager will be responsible for collecting detailed information about a client’s circumstances, mental health challenges, and overall functional status to identify individual needs and develop a comprehensive plan of care. The Case Manager will identify both present and possible future needs of the patient and family/caregiver that address all dimensions of wellness. This assessment will include age-specific physical, psychosocial, environmental, financial, and health status expectations.
• Planning: The Case Manager will identify specific objectives, goals, and actions, as identified during the assessment process. Acting as a patient advocate, the Case Manager will collaborate with the physician, the patient and family, and members of the healthcare team to formulate a collaborative plan of care and follow-up on treatment goals.
• Implementation: The Case Manager will utilize specific interventions that will lead to accomplishing the goals and time frames of the shared plan of care and work effectively with the healthcare team to determine the necessary steps to achieve the plan of care. The Case Manager will incorporate knowledge of alternative funding sources, benefit plans, and contractual information to promote appropriate quality, cost-effective care for clients.
• Coordination: The Case Manager is responsible for obtaining the appropriate authorizations and completing utilization reviews in line with coverage guidelines, communicates with the client and family, physicians, healthcare members, community, and payor representatives. The Case Manager facilitates continuity of care throughout all access points involving the Health Plan, discharge planners, physicians, and other appropriate staff.
• Monitoring: Obtains sufficient information from all relevant resources in order to determine the effectiveness of the plan of care and services provided.
• Evaluation: The Case Manager assesses and reassesses the patients’ progress at appropriate and repeated intervals throughout the treatment process. If progress is static or regressive, the Case Manager will identify possible contributing factors and suggest appropriate interventions to obtain optimal outcomes. The Case Manager will modify the plan of care, as necessary, in coordination with the healthcare team, family members, and providers.
• Communication: The Case Manager will communicate both verbally and electronically with the patient and the healthcare team, maintain accurate documentation including a plan of care, outcomes, statistical reporting, and logs that adhere to all departmental, legal, and regulatory requirements.

Skills

• Knowledge of managed care principles, utilization management, case management, and healthcare provided throughout the continuum of care.
• Knowledge of physical and psychological characteristics of disease processes recognizes potential clinical problems and recommends interventions in a preventative, proactive manner.
• Excellent interpersonal verbal and written communication skills.
• Ability to problem-solve and good time management skills.
• Ability to access and evaluate community resources to meet patients’ needs.
• Ability to handle multiple tasks at a time and remain organized.
• Ability to work autonomously as well as the ability to work collaboratively on a treatment team.
• Excellent computer and IT system knowledge.
• Possesses the knowledge and skills necessary to communicate with third-party payers.
• Establishes and maintains a good rapport with physicians and interacts well with all internal and external customers in a professional and courteous manner.

Experience

• Requires six (6) months of clinical experience in an HMO, medical group, affiliated model, hospital, or medical/office/clinic setting.

Position Requirements

• Education:
  • Requires a Master’s Degree in Social Work, Psychology, Counseling, and/or a Master’s Degree with five (5) Years of relevant social work experience.

Preferred Position Requirements

• Three (3) years of experience in utilization management and/or case management is highly desirable.
• Managed care experience.

Licenses / Certification

• LCSW- preferred
• Certification in Case Management (CCM, ACM).
• Valid California Driver’s license.

Competitive Benefits (After 30 Days)

• Medical/Health
• Dental
• Vision
• Holiday Pay
• PTO
• Sick Days
• 401K Matching

Additional Job Description

The above job description is intended to describe the content and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.

Signatures below indicate that this job description has been reviewed with the employee by the supervisor and that the employee has been given the opportunity to ask questions. (A copy has been provided for future reference). California Rehab Campus reserves the right to change, add or delete at any time from this Job Description to meet the needs of the organization.