Actalent is Hiring a Behavioral Health Care Coordinator // Hybrid!

Job Description

The Behavioral Health Care Coordinator plays a pivotal role as a core member of the collaborative care team, working alongside the enrollee’s medical provider, mental health team, and the larger Concierge Care Coordination team. This position is responsible for coordinating and supporting the mental and physical health care of enrollees within an assigned behavioral health population caseload. The coordinator collaborates with medical providers and, when appropriate, other mental health providers, to manage care for all lines of business, including managed care contract programs that serve adults and children with severe mental illness (SMI).

Responsibilities

• Lead a multidisciplinary team to identify high-risk clients, address care gaps, and collaborate with providers to enhance patient outcomes and care quality.
• Manage services for medical, behavioral, and substance use needs, including crisis intervention, discharge planning, and complex case management.
• Engage with Medical Directors and care management staff to direct appropriate utilization and data capture.
• Educate members, providers, and team members on care coordination services and the proper use of these services, including reducing inappropriate admissions and placements.
• Conduct thorough needs assessments, including risk stratification, to determine health, psychological, educational, and social needs.
• Review the daily census for enrollees admitted to the hospital within your panel, assess the need for ongoing care coordination, and facilitate discharge planning.
• Conduct outreach to enrollees with patterns of emergency room visits to identify contributing factors and develop strategies to reduce avoidable admissions.
• Develop individualized care plans in collaboration with physicians and enrollees, setting specific, measurable, achievable, realistic, and time-bound (SMART) goals.
• Participate in team huddles and multidisciplinary team conferences to review strategies, address immediate needs, and develop action plans for quality care.
• Identify and assess barriers when members do not meet treatment goals, fail to follow care plans, or miss appointments.
• Provide education on disease processes, healthy lifestyle changes, and self-management strategies consistent with clinical practice guidelines.
• Deliver brief behavioral interventions using evidence-based techniques such as motivational interviewing, problem-solving treatment, or behavioral activation.
• Conduct in-home assessments as needed to evaluate the member’s home environment for safety, setting appropriateness, and the availability of needed supplies and medications.
• Monitor resource utilization, including hospitalizations and long-term care services, to promote optimal use consistent with organizational goals.
• Maintain accurate documentation in compliance with quality standards and accreditation requirements for care management programs.
• Serve as a liaison between members, providers, medical directors, and external organizations to coordinate care and resolve authorization issues.

Essential Skills

• Case management
• Behavioral health
• Care coordination
• Chronic disease management
• Plan of care management
• Managed care experience
• Medicaid knowledge
• Needs assessment

Additional Skills & Qualifications

• Bachelor’s Degree in social work and/or Nursing
• Master’s Degree in social work (MSW) or Nursing (Preferred)
• Psychiatric/Mental Health Nursing Certification (Preferred)
• Registered Nurse licensure in the state of Florida, or State Licensure in Social Work or related field (Preferred)
• Certified Case Manager (Preferred)
• License Clinical Social Work (LCSW), Licensed Mental Health Counselor (LMHC) – (A Plus)
• Psychiatric- Mental Health Nursing Certification (A Plus)
• Certified Addictions Registered Nurse (CARN) (A Plus)
• 3-5 years of clinical experience
• 3-5 years of experience in a managed care, health plan, or insurance setting
• Experience with Utilization Management and Care Coordination
• Knowledge of Medicaid/Medicare Regulations
• Knowledge of Microsoft Office and internet software
• Knowledge of EPIC and similar systems (preferred)

Work Environment

This role offers a hybrid work environment, with 1 day in the office, either Tuesday or Thursday. When working from home, candidates must have a private space with a closed door to maintain confidentiality due to members' private health matters. Equipment necessary for the role will be provided.