BH Care Manager

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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 Behavioral Health (BH) Care Manager, provides care management services to WellSense members with behavioral health and substance use needs.  This role functions as part of an interdisciplinary team and collaborates closely with Utilization Management and Care Management staff, Pharmacy, and leadership. The BH Care Manager supports members across the healthcare continuum, serving as liaison between WellSense  and hospital staff, primary care providers (PCPs), and other healthcare professionals. Responsibilities include the management of complex and non-complex cases, coordinating transition of care, discharge planning support, conducting assessments and developing plans of care, and care management interventions.  

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/Responsibilities: 

• Deliver comprehensive, client-centered behavioral health and substance use care management and disease management services 

• Conduct assessments, screenings, and interventions telephonically as well as in the community or at facilities when required and approved by the supervisor or manager, in alignment with WellSense policies and procedures 

• Develop, implement, and monitor individualized care plans (ICPs) that address members’ needs and barriers to healthcare taking into consideration members’ preferences, input, and disposition as well as input from the care team 

• Facilitate transition of care from inpatient facilities to post-acute settings or to the community by coordinating with facilities, 24-hours diversionary services, outpatient services, utilization management, care management teams, and other healthcare professionals ensuring a seamless transition, integrated care, and best practices.  

• Make use of behavioral health techniques like Motivational Interviewing, Active Listening, Harm Reduction, Strength-Based approach, Trauma-informed care, and CBT. 

• Coordinate care and ensure timely service delivery across the healthcare continuum by identifying service gaps, securing follow-up appointments, and engaging with providers, facilities, and community-based organizations. 

• Provide educational materials and psychoeducation to members and families about mental health and substance use disorders and their treatment 

• Outreaches to members for medication monitoring and to encourage them to comply with medication regimens. Educate members as needed regarding the role and use of medications in their recovery. 

• Collaborate closely with members, families, and caregivers as well as with care team members, providers and state agencies in treatment planning and care coordination activities ensuring effective communication, support, and integrated care 

• Serve as liaison between hospitals, PCPs, BH providers, external agencies, and the care team 

• Conduct and document assessments, interventions, and coordination of care activities in accordance with WellSense policies and with regulatory and accreditation standards 

• Support initiatives that reduce hospital readmissions and improve health outcomes, functional status, and overall quality of life 

• Participate in ongoing quality assurance and quality improvement activities and internal and external audits 

• Provide crisis intervention support using clinical judgment to de-escalate situations and assist members in stabilizing their conditions. 

• Attend to and takes part in round meetings presenting cases and/or providing recommendations and support to other care managers. 

• Meet departmental productivity and quality standards; maintains designated caseload volume and adheres to turn around times standards. 

• After-hours availability as needed 

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

• Performs other duties as assigned. 

Supervision Exercised: 

• No direct supervision exercised  

Supervision Received:  

• General supervision is received weekly.  

Qualifications:  

Education:  

• A master’s or doctoral degree in a behavioral health field such as psychology, clinical counseling, or social work  

Experience:  

• Two or more years related experience in Mental Health, BH Case Management, and/or substance abuse treatment  

Experience Preferred/Desirable: 

• Experience with Medicaid recipients and community services. 

• Direct experience in care management or care coordination 

• Experience in a health plan or insurance environment  

• Experience providing services to children, adolescents, adults and/or geriatric population 

• Prior experience providing services to members with SUD or co-occurring disorders 

• Bilingual/Multilingual  

Certification or Conditions of Employment:  

• Must hold a current certificate or state licensure  

• Massachusetts: LICSW, LMHC, LMFT, or LADC1 (with additional licensure) 

• New Hampshire: LICSW, LCMHC, LMFT, or MLADC (with additional licensure) 

• Certified Case Manager (CCM) preferred 

Competencies, Skills, and Attributes:  

• Able to work in a fast-paced environment; ability to multi-task. 

• Experience with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry processing applications. 

• Strong analytical and clinical problem-solving skills. 

• Demonstrated ability to successfully plan, organize, implement and manage projects within a health care setting.  

• Detail oriented and excellent analytical skills. 

• Ability to work both independently and as part of a team. 

• Strong oral and written communication skills; ability to interact within all levels of the organization. 

 Working Conditions and Physical Effort:  

• Travel to member locations when required. 

• Work is normally performed remote but may require travel into the community and community but as well as 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

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