Health Plan Behavioral Care Manager (Onsite)

Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Job Summary:

Assumes responsibility for utilization and case management of behavioral health cases. Collaborates with other staff in co-management of more complex cases. Contributes to the Population Health Plan Initiative.

Job Requirements:

Education and Work Experience:

• Associate's/Technical Degree or equivalent combination of education/related experience: Required
• Bachelor's Degree: Preferred
• Master's Degree in social work (LCSW): Preferred
• Doctor's or Master's Degree (LMFT) from an accredited school: Preferred
• Five years' clinical experience, including direct patient care: Preferred

Licenses/Certifications:

• Licensed Clinical Social Worker or Licensed Psychologist: Required
• Licensed Clinical Social Worker (LCSW) or Psychologist (PSYCH): Required

Facility Specific License/Certifications:

• Licensed Clinical Social Worker (LCSW) in state of practice: Required

Essential Functions:

• Case manage or co-manage with the care management nurses for employees/dependents with behavioral health issues.
• Develops care plans and works with the members and their providers toward effective outcomes. Supports the proper utilization of resources.
• Performs concurrent and retrospective medical record/case review in accordance with the Care Management Program utilizing appropriate medical resources and clinical decision support tools.
• Functions as liaison to members, providers, case coordinators, discharge planners, contracted health plans/partners and internal departments. Counsels members in behaviors conducive to health. Acts as resource for our care management nurses and wellness coaches. Develops focused programs, as needed (i.e. drug seeking members).
• Assists with analytics review of claims data from varied sources relative to potential patient needs and program development. Develops programs in support of our population health initiative.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

About Us

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.