Field Case Manager

Position Summary:

• Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues

Duties:

• Utilizes critical thinking and judgment to collaborate and inform the case management process to facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education for members using care management tools and resources.
• Uses care management tools and information to evaluate members, conducts comprehensive evaluation of member’s needs/eligibility, and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
• Identifies risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Enhancement of Medical Appropriateness and Quality of Care: - Using holistic approach consults with case managers, supervisors, Medical Directors, and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the members’ benefits and healthcare needs.
• Utilizes motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information, and support to empower members to make ongoing independent medical and/or healthy lifestyle choices.
• Helps members actively and knowledgably participate with their provider in healthcare decision-making.
• Monitoring, Evaluation and Documentation of Care.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Experience:

Required Qualifications :

• Bachelor’s degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling), LMHP, RN/LPN, QMHP, LMSW, LBSW, MSW or BSW
  2 years’ experience in behavioral health, social services, or appropriate related field equivalent to program focus
  Up to 70% of travel will be required in assigned region
• Preferred Qualifications
• Case management and discharge planning experience preferred
• Managed Care experience preferred

Education:

• Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling), QMHP, MSW or BSW.

Software Galaxy Systems, LLC (SGS) is an award-winning Contingent Workforce Services firm providing a broad range of integrated suite of services through a global delivery platform. SGS brings innovative talent management strategies to empower its clients to stay focused on growth of their core competencies. SGS has developed a comprehensive process-oriented methodology to manage high-volume contingent labor, payroll services and SOW’s for today’s competitive landscape.

SGS is proud of the partnerships it has built with its clients, MSP’s, and employees which has allowed it to deliver unparalleled service to its wide-ranging customer base. SGS is a certified minority owned enterprise that provides innovative yet practical solutions, from concept through execution. We combine technology with strategy and aim to deliver results today that endure tomorrow. SGS’ client centric approach delivers unparalleled value with vastly responsive, streamlined and highly process oriented workforce solutions.

SGS has been awarded and acknowledged by leading MSP’s (i.e., KellyOCG, TAPFIN, Guidant Global, etc.) for its exemplary performance in the contingent workforce space.