Job Details

Behavioral-Health-Case-Manager

Company name
Oregon Dental Service

Location
Portland, OR

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Let’s do great things, together

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Currently, Moda Health is seeking a Behavioral Health Case Manager. This position will perform case management within the boundaries of accreditation organization standards to ensure appropriate and effective care is delivered timely and within the appropriate setting for Moda members. Interacts with the member, family and care providers within a Motivational Interviewing framework to develop, coordinate and monitor the member’s treatment plan.

PRIMARY FUNCTIONS

01. Interacts with members within the spirit and framework of Motivational Interviewing to promote member activation and engagement in a productive course of treatment.

02. Investigates opportunities for health care alternatives and collaborates with members and providers to develop cost effective treatment plans for members.

03. Utilizes acquired knowledge and skills to coordinate and support members through the course of their illness and or recovery.

04. Collaborates with medical and BH care coordinators, case managers and health coaches to ensure integrated medical and behavioral treatment plans; provides BH consultation and training as appropriate to Moda Health nurses and coaches; participates in medical case rounds.

05. Reviews multiple data sources to identify members potentially appropriate for BH case management. Reviews cases referred for case management from internal or external sources for appropriateness to case management.

06. Works closely with patients, families and providers, usually by telephone.

07. Participates in care conferences telephonically or in person in complex cases to ensure that member needs are met and transitions in care are smooth.

08. Outlines a clear proactive plan of care with patient goals and objectives and measurements to attain the same in accordance with accreditation organization standards.

09. Consults with Moda Health medical directors to ensure clinically appropriate determinations.

10. Ensures compliance with accreditation organization standards as well as medical policy and criteria and accepted standards of care while performing Utilization Review and Service Authorizations for members enrolled in Case Management.

11. Participates in focused Quality Improvement projects.

12. Collaborates with other Moda departments to resolve claims adjudication, quality of care, member or provider issues.

13. Maintains caseload within guidelines outlined in Medical Management Caseload Guidelines Policy and Procedure.

14. Utilizes the CaseTrakker system for consistent and accurate documentation of all activity and notes related to each case.

15. Utilizes the contracts available within Moda Health whenever possible.

16. Documents cost savings where appropriate.

17. Writes accurate, readable narrative reports.

18. Reports on any case placed on the High Dollar Report in Rounds meetings.

19. Develops professional relationships with other Moda departments. Coordinates with Customer Service for complete and accurate benefit determination.

20. Identifies and utilizes community resources as part of the Case Management function.

21. Provides approvals and denials of requests in a professional, positive manner.

22. Completes prognosis reports within 3 days or sooner as assigned.

23. Identifies problems and researches alternative solutions.

24. Contributes to the department as a team player.

25. Performs other duties as assigned.

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

Required Skills

1. Current unrestricted Oregon license as mental health professional, (e.g., Licensed Psychologist, Licensed Clinical Social Worker, Licensed Professional Counselor, Licensed Marriage and Family Therapist) or Registered Nurse.

2. Requires at least three years recent experience in behavioral health, (mental health and/or chemical dependency), treatment setting; or two years recent experience in health plan care management position.

3. Certification in case management or utilization review/management required or ability to obtain within 24 months of hire.

4. Proficiency in Motivational Interviewing.

5. Type a minimum of 35 wpm on a computer keyboard.

6. Proficiency with personal computer programs such as Microsoft Word and Excel.

7. Analytical, problem solving, memory retention, organizational and detail oriented.

8. Excellent verbal and interpersonal communication skills including management of the angry customer.

9. Ability to work well under pressure.

10. Ability to come into work on time and on a daily basis.

11. Project a professional business image telephonically and in person.

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Health plans in Oregon, Washington and Alaska provided by Moda Health Plan, Inc. Dental plans in Oregon provided by Oregon Dental Service. Dental plans in Alaska provided by Oregon Dental Service dba Delta Dental of Alaska.

Company info

Oregon Dental Service
Website : http://www.odshealthplans.com

Company Profile
At Moda Health, we’re passionate about helping you on your journey to be better. We know that dealing with health concerns can be tough – and that it is a juggling act to fit in healthy choices every day. That’s what we’re here for. We’ll be your guide, your supporter, your fan club and your partner ready to help you every step of the way.

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