Are you interested in improving the quality of life for the people in your community? Do you have a passion for ensuring that those with mental health and substance use disorders receive the services they need? Are you looking for a place to work that is committed to the development of staff and matching people to work they love? A place that values a diverse workforce that strives for excellence while maintaining a healthy work/life balance?

Then come join us!

Southwest Michigan Behavioral Health (SWMBH) is a $200 million governmental entity managing multiple Michigan Department of Community Health benefits management contracts and business lines over an eight county region in Southwest Michigan.

SWMBH is seeking a Care Management Specialist II. This position provides utilization management functions as part of the Prepaid Inpatient Health Plan (PIHP) benefits management system. This includes providing utilization review and management, access, care coordination and brief/crisis counseling for mental health and substance abuse services, as well as performing the identification, analysis, and resolution of resource utilization outliers consistent with established protocols, policies, and procedures.

DUTIES and RESPONSIBILITIES:

• Completes initial or annual Level II Assessment tools (ASAM and LOCUS) and care coordination plans (CCP) for enrollees identified as having BH or SUD, and/or I/DD service and support needs.
• Develops with the enrollee and the Integrated Care Team (ICT), an Individual Integrated Care Service Plan (IICSP).
• Provides care coordination for services and supports such as psychiatric, psychopharmacological, rehabilitative, and habilitative in response to needs identified in the Level I Assessment, the Level II Assessment, and/or the IICSP.
• Manages transitions among acute and sub-acute levels of care and the community.
• Ensures urgent and emergent care (including emergency department and/or inpatient diversion) due to exacerbation of BH, SUD, and/or I/DD conditions (including crises secondary to medical or chronic illness).
• Provides care coordination regarding health, wellness, and preventative services for BH, SUD, and/or I/DD specialty populations, including collaboration with CMHSP’s, ICO’s, MHP’s and treatment and community providers
• Communicates, coordinates, and monitors peer support/peer health navigator services, including enrollee engagement, health advocacy, and training in self-management of chronic illness.
• Documents in the applicable electronic systems, including the SWMBH MCIS, Integrated Care Bridge Record (ICBR) and communicate with the enrollee and Providers, as needed.
• Screens referrals, secures financials, and assigns appropriate level of care to provide services to customers.
• Recommends new models and innovative practices to improve UM functions and cross-collaborative service efficiencies and effectiveness.
• Documents all data collected and all analyses conducted during the review process.
• Identifies quality concerns related to programs, specific practitioners or consumers, and notifies the Provider and relevant committees of the concerns.
• Performs other related functions, as assigned.
  

ESSENTIAL FUNCTIONS:

• Makes service determination decisions for specific members for medically necessary managed care services within a person-centered customer choice framework based on based on identified medical necessity criteria and level II screening tools.
• Provides brief and crisis counseling and intervention as outlined by the SBIRT model
• Provides the member information and education about their applicable mental health or substance use issues based on the Level II Assessment including advising in clear, respectful terms about the potential harm of and to decrease or abstain from substance use, encouraging members to set goals to decrease substance use or move down a path of recovery and to identify specific steps to reach those goals
• Offers resources for and talk through behavior change/support skills that will reduce mental health or substance use issues and limit negative consequences and makes referrals for further care and coordinate the care for the member.
• Provides care coordination including services and coordination with others in care planning and monitoring the individual’s physical and mental health, and his/her goals and outcomes.
• Impacts the delivery of care at the system level through direct utilization management, feedback of performance data, training, and supported consultation.
• This position primarily works in an office environment. It requires frequent sitting, standing and walking. Required to travel locally and regionally in own vehicle and to attend conferences or other related events.

QUALIFICATIONS:

• Master’s Degree in Social Work, Psychology, or a Human Services related field is required.
• Licensed Master Social Work (LMSW), Limited License Psychologist (LLP), Licensed Professional Counselor (LPC), or Registered Nurse (RN) is required.
• Certification as an Addiction Counselor is preferred.
• Experience in the mental health and/or substance abuse field is required. Experience with all target populations and direct experience performing benefits and/or utilization in a managed care setting is preferred.
• Strong oral and written communication skills, and excellent interpersonal skills; excellent critical thinking and organizational skills; demonstrates effective interpersonal skills and customer service practices for a diverse population, primarily using telephonic methods.
• Ability to manage multiple projects simultaneously and meet required deadlines.
• Ability to collaborate with others within a team environment and effectively work independently.
• Understand the Diagnostic Statistical Manual (DSM) IV/V and demonstrate competence in making mental health and chemical dependency provisional diagnoses with available information.
• Understands mental health and chemical dependency inpatient, partial hospital, Intensive Outpatient Program (IOP) and outpatient modalities based on an assessment and medical necessity criteria.
• Ability to establish effective working relationships rapidly by telephone to gather necessary information quickly and accurately under occasionally difficult circumstances.
• Ability to relate and discuss benefit, medical necessity, and clinical information with stakeholders.
• Demonstrates knowledge of behavioral health resources
• Technology literate, and working knowledge of Microsoft Office applications including, Word, Excel, Outlook, and PowerPoint.
• Life experiences with diverse racial, ethnic, and cultural backgrounds, including experience with behavioral health issues is preferred.
• Must be supportive of culturally competent recovery-based practices and person-centered planning as a shared decision making process.
• Must support a trauma informed culture of safety to aid consumers in their recovery process.

Individuals of diverse racial, ethnic, and cultural backgrounds including those with lived experience with behavioral health issues along with bilingual candidates are encouraged to apply.

Please apply through the Southwest Michigan Behavioral Health website at www.swmbh.org by July 22, 2022. Emailed resumes will not be accepted.

Position includes a full benefit package and salary is commensurate with experience.

SNAPSHOT

Job Title: Care Management Specialist II

Experience: 1 Year

Position Type: Exempt

Industry: Healthcare

Required Travel: Minimal

Manages Others: No

Keywords: Utilization Management, Behavioral Health, Substance Use Treatment, Clinician, Counselor, Mental Health, Care Coordination, Care Management Specialist