Job Description

The Case Manager supports the Call Center team in responding 24/7 to individuals in need of services, orientation and/or crisis by providing case management and referring clients to the appropriate level of care after consulting with the Clinical Manager, Clinical Supervisor, Director, VP of Clinical or Psychiatrist. The Case Manager uses clinical structured data to determine based on eligibility criteria for a variety of program services based on member’s needs and benefits under the health plan. The goal of the services provided is to support client wellness. The Case Manager is responsible for documenting the services authorizatio n and complying with the established processes to coordinate services with the providers. Case Manager educates clients, their representatives and their dependents about the coverage benefits and community resources available. The case manager is responsible for providing support in the coordination and notification of appointments scheduled for our clients, in accordance with the timeframes established in the organization's policies. This role also ensures the accessibility and care of the clients.

Responsibilities and essential duties:

1. Upon answering the telephone, FHC Call Center staff identify themselves by name, title, and organization’s name. Answers the telephone in the company’s established time frame, with a clear and pleasant tone of voice, and with an appropriate language expression.
2. Shows appropriate communication skills, effective listening, and case management skills to deal with challenging situations.
3. Provide phone support to members calling the Call Center to conduct needs assessments, brief interventions, facilitating referrals and supportive engagement.
4. Verifies the member eligibility before processing and registering the phone call in FHC’s platforms.
5. Educates the member about our programs and coverage’s benefits.
6. For initial screening, the Case Manager does:

• • Structured clinical data acquisition: (Structured clinical data is collected using scripts).
  • Conducts telephone interviews to gather the necessary data using structured clinical data (scripts) and Triage Logic platform logs the health care services, coordinates appointments, makes the appropriate referrals, and service authorizations.
  • Demonstrate knowledge when using the program to log the health care services and the other technological applications available.
  • Collection and transfer of non-clinical data
  • Activities that do not require evaluation or interpretation of clinical information.
  • Performance of review of service request for completeness of information.

7. Maintains the confidentiality of the documents and the information received.

8. Facilitate access to immediate services if an individual reports risk of suicidal or homicidal ideation or threats.

9. Provide solution-focused interventions such as helping client practice calming/coping skills, facilitating linkage to ongoing support, and explaining the mental health services available.

10. Conducts the interview process and documents according to the requirements of the Health Insurance Portability and Accountability Act (HIPAA) and law 408.

11. Have immediate access to licensed clinicians or clinical manager or supervisor.

12. Consult with Call Center psychiatrists and/or licensed clinicians whenever necessary.

13. Comply with the guidelines and established criteria for the different processes.

14. Carry out delegated duties such as:

• • Outbound calls for the purpose of requesting a copy of the medical/clinical record and scheduling (to verify next appointments, attendance at previous appointments, coordinate services and service authorizations.)
  • Faxing materials
  • Mailing/e-mailing already identified materials.
  • Follow up initiative referrals.
  • TTY validation.
  • Follow up Call Backs.
  • In charge of administrative discharge of cases previously authorized by Utilization Review Department

15.  Comply with the established quality parameters for abandonment rate, average speed of answer, coordination of services and notification, calls classification and routing, and first call resolution.

16.  Interacts with providers, clients, and other professionals in charge of member’s care to guarantee the efficiency and continuity of service.

17.  Manages the emergency calls according to the standard procedures established in the practice of mental health services and according to the internal policies and procedures established by the organization relevant to the Access Center.

18.  Validate the registration process of the admissions to mental health services.

19.  Enter the system the inpatient admission registration when the facility cannot complete the task.

20.  Assist members and/or providers with the transition of care by identifying resources to support the discharge plan.

21.Receives and verifies referrals for the coordination of appointments and request additional information, if necessary.

22.Timely coordination of care for clients and dependents is essential.  Applications must be submitted entirely via Web Service.

23.Contact clients and dependents to inform them of the appointments that have been scheduled within the specified timeframes.

24.Issue authorizations for services coordinated and inform clients/dependents.

25.Notify the relevant parties of any coordinated appointments that may be necessary.

26. Provide mental health first aid to members in crisis.

27. Responsible for calling psychiatric inpatient facilities to validate admissions and discharges.

28. Responsible for entering information related to admissions and/or discharges in the Web Census platform.

29. Provide backup to Utilization Review Department out of business hours including document in the appropriate platform services request, provide information of service request status, operational hours, appointment of representative orientation and other.

30. Participate in a new project as assigned by the supervisor.

31. Participates in the mandatory training, such as the Annual Compliance Plan, Human Resources & Departmental, URAC, NCQA and CMS guidelines.

32. Applies in a consistent manner the policies and procedures that are pertinent to the Access Center at FHC.

33. Comply with the established attendance and punctuality policies.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion, and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state, or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.  We take pride in creating highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: or 1-800-852-3449 .

• Education: Bachelor of Psychology, Social Work, Social Sciences, or Biopsychology with minor in Psychology.
• Licenses: Valid and current active license for Social Work
• Professional associating membership ( colegiación )
• Comply with the continuing education hours as they correspond to the specialty
• Two or more years of experience in the health field
• Fully bilingual
• Knowledge in Microsoft Office

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