Responsibilities
- Serve as the main point of contact for individuals with behavioral health concerns, offering support ranging from coaching to intensive case management to improve healthcare navigation and self-care through behavior change.
- Conduct phone-based clinical and psychosocial evaluations to assess members' health and wellness needs.
- Create personalized, condition-specific care plans using clinical information systems, including short- and long-term objectives.
- Schedule regular phone check-ins with members to monitor progress and identify emerging needs.
- Coordinate with treating providers in complex cases that require case management involvement.
- Locate digital, phone-based, and local community resources to help members meet their health goals and support access to these services.
- Integrate preventive care and healthy lifestyle promotion into routine member interactions and coaching sessions.
- Maintain accurate documentation and ensure all actions comply with organizational, regulatory, and accreditation standards.
- Work alongside case and condition management teams to co-manage members needing additional support.
- Engage in continuous training and education on behavioral health and medical topics.
- Support members in building skills for managing their health conditions independently.
- Use evidence-based strategies to encourage sustainable behavior change.
- Help members interpret health information and make informed decisions.
- Monitor member engagement levels and adjust outreach strategies as needed.
- Ensure consistent follow-up with high-risk or chronically ill members.
- Apply clinical expertise to assess psychosocial factors impacting health outcomes.
- Maintain member confidentiality in all communications and documentation.
- Adapt communication style to meet diverse cultural and emotional needs.
- Identify barriers to care and collaborate on solutions.
- Utilize telehealth platforms effectively for remote service delivery.
- Stay current with best practices in behavioral health and care coordination.
- Respond to member inquiries promptly and professionally.
- Escalate urgent clinical concerns according to protocol.
- Support transitions of care when members change treatment settings.
- Participate in quality improvement initiatives as needed.
Work Arrangement
Remote
Responsibilities
- Function as a primary contact for members with behavioral health needs with the depth of engagement ranging from coaching interventions to intensive case management interventions. The overall goal is to help members navigate the health care system and develop condition self-management skills through behavior change. Provide members with resources and tools to assist in health-related decision making. Conduct telephonic clinical and psycho-social assessments that address the health and wellness needs of the Organization's members.
- Develop case or condition-specific plans of care using the clinical information system to establish short and long-term goals. Establish a plan for regular telephonic contact with each member to review progress and assess the potential for additional needs.
- Communicate with the member’s treating provider or providers in more complex clinical situations requiring case management intervention.
- Identify on-line, telephonic and community-based resources that can assist the member to achieve and maintain their personal health goals and assists the member to access those services.
- Pro-actively incorporate lifestyle improvement and prevention opportunities into member interactions and coaching.
- Ensure that all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.
- Collaborate with case and condition management teams to provide co-management activities for members who require additional services. Participate in ongoing training and educational activities related to behavioral health and medical topics.
- Other duties as assigned or requested.
Not specified
