Great Opportunity!
* Preferred Skills: Masters Degree in Social Work or Psychiatric Nursing and appropriate licensure in MD. Five+ years Psychiatric/ CD/ Case Management experience preferred. Extensive experience working with clients dealing with psychiatric illness, and chemical dependency as well as clients who are dual diagnosed. Must be able to manage the following duties in Behavioral Health Out Patient Setting: Intensive Case Management, Discharge Planning, Referral to Community Resources, Tracking, Telephonic Outreach and Coordination of Care, and Crisis Intervention. Thorough and timely computer documentation is a must. Preferred skills include candidate being able to multi task and to be experienced working as part of an interdisciplinary team.*PURPOSETo ensure that members referred to the Behavioral Health Network for ambulatory care receives appropriate, coordinated, and continuous care. To review referrals, perform concurrent reviews, and authorize continuing care. To engage in collaborative treatment planning with Network consultants and Kaiser Permanente staff.This position consistently supports compliance and the Principles of Responsibility (KaiserPermanente’s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente’s policies and procedures. In addition, Regional leaders are accountable for communication, implementation, enforcement, monitoring and oversight of compliance policies and practices in their departments.Consistently demonstrates the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.ACCOUNTABILITIES: (List of 4 - 6 primary responsibilities, not activities, in their order of importance)1. Prospectively reviews all Behavioral Health ambulatory referrals. Identifies benefit eligibility, reviews appropriateness for referral based on established referral criteria.2. Monitors system for notification of patient and provider if referral does not meet criteria.3. Conducts Concurrent Review on all cases referred to the Network, ensuring that cases receive care at the appropriate level and follow established practice guidelines and behavioral treatment plans.4. Authorizes additional visits to Network consultants after reviewing clinical and administrative issues in each case. Consults with KP staff psychiatrists as appropriate.5. Assists in ensuring that documentation on all cases is accurately maintained in a timely manner.6. Collaborates with Network consultants, Kaiser Permanente staff, patients, and other health plan personnel to coordinate care for members referred to the Behavioral Health Network.7. Assists in discharging planning with the consultants, e.g., recommendation of community resources, Kaiser Permanente treatment programs, etc.8. Participates in orientation of Kaiser Permanente staff´s members regarding the referral process.9. Maintains working knowledge of Health Plan contracts with employer groups and Medical Group contracts with consultants.10. Assists Behavioral Health QA/AI committee and Network Manager in establishing and tracking quality assurance activities.11. Resolves telephone and written inquiries from members and consultants.12. Maintains and updates knowledge of treatment approaches, philosophies and techniques for Mental Health/Behavioral Health diagnostic categories.13. Maintains knowledge of ICD-9 and CPT coding categories.14. Collaborates with Behavioral Health Referral Assistants and Manager in maintaining and improving the Network referral process.15. Assists Behavioral Health Network Manager with special projects as assigned.MINIMUM REQUIREMENTS Relevant Years of Experience:- Two years of experience in Mental/Behavioral Health Care are required.- Experience in both ambulatory and in-patient setting is preferred.- Knowledge of Behavioral Health Care theory and techniques is required.- Experience and the ability to communicate effectively with consultants, members, and Health Plan/MAPMG providers are required.- Knowledge of quality resource and utilization management techniques is required.- Ability to work independently and manage multiple priorities are required.- Good computer skills and the ability to use standard software applications are required.Education and/or Classes:- Master´s Degree in equivalent Health Care field with current and appropriate licensure is required.License, Certification and/or Designation:- LCSW or Psychiatric RN is required.- National Provider Identification (NPI) required.