Clinical Case Manager
Humana (Fort Worth, Texas)

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Job Description: Corphealth, a wholly owned subsidiary of Humana, is seeking qualified applicants for the position of Case Manager for our office in the Arlington area. The Case Manager will perform case management collaboratively with medical case managers for members who have both medical and behavioral health issues. Key areas of responsibility: 1. Participate in case management by providing continuum of care services and care establishment for members identified for Integrated Case Management (ICM) services in an effective and efficient manner in accordance with Corphealth Clinical Department and Integrated Case Management Program Policy and Procedures. 2. Complete at least 50 telephonic contacts per week with either members, providers, or Humana counterparts. At least 45% of these phone calls should be successful (meaning a member, provider, or Humana counterpart was reached telephonically). 3. Maintain an average caseload of 700 points (as defined in the program description). 4. Determine the needs of the identified ICM members and work with providers to develop an individualized plan of care, make appropriate and timely referrals, and provide care coordination assistance to members, guardians, and providers. 5. Work collaboratively with medical case manager to determine case ownership, provide consultative assistance with difficult cases and participate in joint care plan. 6. Close cases efficiently and appropriately as indicated by member progress. 7. Locate atypical community-based resources to provide resources adjunct to treatment plan interventions. 8. Adhere to state and federal regulations, including URAC, NCQA, federal law and individual state Departments of Insurance. 9. Report on specific Personal Care Management assignments and caseload specifications such as evaluating outliers, reporting trends, analyzing outcome measurements, and making recommendations. REQUIREMENTS: 1. Health Professional with a minimum of an Associates Degree in nursing or a Masters degree in the behavioral health care field such as social work, psychology, or related field from an accredited university. 2. Possess a current, valid, and unrestricted license in the State of Texas or possess a reciprocal license from another state. Such licenses are Licensed Masters Social Worker (LMSW or LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), PhD/EdD, or Registered Nurse (RN). 3. Certification as a case manager (CCM) preferred, CCM certification eligible required. 4. RNs must have at least three (3) years clinical practice experience. 5. At least one (1) year experience in mental health or substance abuse case management. 6. Preferred one (1) year experience in medical case management. 7. Ability to exercise sound clinical judgment and engage in ethical behavior. 8. Ability to develop and implement treatment plans. 9. Ability to conceptualize and present clinical cases in concise and clear manner. 10. Ability to provide training and feedback to medical case managers as needed Applicants that do not meet the qualifications listed above will NOT be considered.

Minimum Education Required: Masters Years of Experience Required: At Least 1 Year Expected Travel Time: None