Manager Case Management, Behavioral Health (Triage) - Remote (PA / NJ / DE)

Health & Clinical Services Manager

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.

Job Summary : The Manager provides leadership and oversight of the day-to-day activities of the BH case management team(s) focused on clinical triage and linkage to care for at risk members. They guarantee effective case management activities are consistently applied and achieved. The manager is responsible for ensuring staff evaluate member's clinical condition for both physical and behavioral health through a collaborative approach on care plan development and coordination with members and member's care team. This position collaborates effectively with managers within physical health case management unit, customer service and utilization management to ensure an integrated approach between behavioral and physical health. Is accountable to hire and develop top talent into all levels of positions within the BH unit, strive to meet or exceed unit department goals, ascribe to quality management principles.

Key Responsibilities :

• Oversees the BH staff performing clinical triage function provides leadership and ensuring operational goals are achieved.
• Oversees non-clinical staff performing the triaging and tasking of cases throughout the BH department.
• Proactively identifies opportunities for improvement to the director including but not limited to, changes to referrals from the contact center, BH stratification rules, process changes that promote an integrated PH and BH model, engagement with BH vendors and providers.
• Supports and maintains methods for case coordination between departments so referrals between customer service, PH and BH are coordinated without fragmentation.
• Provides day to day management, counseling, team building, staff development and support required to build and maintain cohesive and effective operations. Ensure all Human Resources department policies and procedures are enforced.
• Leads the development of clinical triage workflows and collaborates internally, providers and community partners to support the delivery of high-quality care management services including best in class screening, crisis interventions, assessment and provider matching.
• Serves as resource for staff to answer policy / procedure questions and to assist with the resolution of difficult inquiries regarding care delivery. In addition, maintains the responsibility of ensuring staff use established case management standards of practice, working to communicate effectively with all members and other internal and external resources.
• Monitors call and case activity to ensure staff interactions with members are focused on identifying barriers and achieving member case goals.
• Ensures that new employees follow appropriate case management processes and policies and works to develop appropriate skill levels in all associates. Provides coaching and education to the BH Case Managers of department resources and guidelines to improve critical thinking and decision-making capabilities.
• Contacts members and care team when needed in complex BH and Medical situations requiring higher level management intervention.
• Assured compliance with all legislative and accreditation standards including NCQA, Department of Health (DOH), FEP, CMS and Department of Labor.
• Participates in evaluation of policies and procedures and makes recommendations for improvement to service efficiency and quality of care.

Qualifications - External :

Education : Active PA Registered Nurse License required (B.S.N. Preferred) or LSW, LCSW, LPC, LMFT

Experience, Knowledge, & Skills :

Fully Remote : This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.