BH Care Coordinator

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

 

 Job Summary: 

The BH Care Coordinator is an integral member of the Behavioral Health Clinical Support (BHCS) team, responsible for delivering telephonic outreach, conducting screenings, and coordinating behavioral health services and community resources for identified members. This role supports both members and providers across service areas and lines of business by facilitating access to appropriate care and promoting continuity of care. 

The BH Care Coordinator works collaboratively with clinical staff and internal departments to ensure members receive timely and appropriate behavioral health services. Responsibilities include triaging cases, supporting care transitions conducting post-discharge follow-up calls and screenings, and responding to member inquiries related to available services and coordinating behavioral health and substance use disorder treatment and community resources.  

 

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

 

Key Functions/Responsibilities: 

• Utilize motivational interviewing techniques to engage members in care coordination via telephonic outreach. 

• Educate members to enhance their understanding of behavioral health conditions, treatment options and the importance of participation in their own care, including how to access resources and navigate the healthcare system. 

• Maintain up-to-date knowledge of community-based services and resources to support appropriate referrals and linkage to care based on members’ individual needs and preferences. 

• Advocate for members and coordinate behavioral health and substance use disorder treatment and community resources. 

• Receive and triage referrals from the department’s toll-free line, email, Population Health Management Platform, ensuring routing to the appropriate WellSense BH program. 

• Receive calls transferred by other departments with or about members with behavioral health needs, including the Member and Provider Service Department. 

• Coordinate and conduct telephonic screenings, arrange wellness visits, and deliver appointment and preventive care reminders, as appropriate. 

• Performs post-discharge follow-up calls and completes the BH transition of care screening 

• Serve as liaison between members, providers, internal departments, and external agencies to ensure timely access to services and resolution of service-related issues. 

• Maintain accurate and timely documentation within the designated medical management information system (e.g. Jiva) ensuring compliance with contractual requirements, internal policy, and accreditation standards. 

• Support department operations by prioritizing and organizing staff assignments, triage tasks, and following workflows and SOPs to prioritize calls. 

• Provide administrative support to the BH CM team primarily, and the BH Utilization Management team as needed. 

• Contribute to continuous improvement by identifying opportunities for improvement in administrative workflows and processes.  

• Perform additional duties as assigned by leadership to support the overall effectiveness and quality of care coordination services. 

 

Supervision Exercised: 

• N/A 

 

Supervision Received:  

• Weekly and ad hoc from Supervisor of BH Clinical Support 

 

Qualifications:  

 

Education Required:  

• High School Diploma (with significant experience coordinating behavioral health services) or; 

• Associate’s degree required in health care or a related area or; 

• Bachelor’s degree in psychology, social work, or related field (preferred)  

 

Experience Required: 

• Experience in either a high-volume customer service call center, data entry office, or health care office administration department  

 

Preferred/Desirable: 

• Prior customer service/call center experience 

• Prior work with Medicaid population preferred 

• Experience coordinating behavioral health and substance use disorders treatment 

• Bilingual/multilingual 

 

Certification or Conditions of Employment:  

• Pre-employment background check 

 

Competencies, Skills, and Attributes:  

• Strong motivational interviewing skills  

• Ability to engage members 

• Strong oral and written communication skills 

• Detail oriented 

• Ability to work independently but also in a team setting  

• Ability to effectively collaborate with health care providers and all members of the interdisciplinary team 

• Demonstrated strong organizational and time management skills  

• Demonstrated ability to successfully prioritize, plan, organize and manage multiple tasks in a face-paced environment  

• Intermediate skill level with Microsoft Office products – Teams, Outlook, Word, Excel, and PowerPoint  

• Knowledge of medical and behavioral health terminology strongly preferred 

 

Working Conditions and Physical Effort:  

• Fast-paced environment 

• No or very limited exposure to physical risk. 

• No or very limited physical effort required 

• Regular and reliable attendance is an essential function of the position 

• Travel within the plan geographic area required 

• Work is normally performed in the community but may require attendance at meetings in the corporate office 

 

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees