JOB DESCRIPTION
Your Role
Reporting to the Manager, Social Services Management, the Case Manager - Clinician, Senior helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Manager - Clinician, Senior helps will offer support in assessing member’s emotional and psychological well-being and providing resource coordination, crisis intervention, substance abuse, and with any behavioral or mental health referrals. The Case Manager - Clinician, Senior helps will be available to physicians and nurse care managers as a consultant for patients with complex psychosocial needs. The position demands for an intensive focus on crisis intervention and counseling, problem-solving and conflict resolution, patient and family management, interdisciplinary collaboration, psychosocial assessments, education, advocacy, and community resource linkages.
Your Work
In this role, you will:
- Collaborate with case managers and other team members to complete member assessments related to social and resource needs to support member access to services
- Collaborate with service coordination staff and act as liaison to ensure timely and accurate response to member need
- Collaborate with providers to support members treatment plan and care needs
- Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team
- Assess members health behaviors, cultural influences and clients belief/value system and evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers
- Efficiently manages and maintains a caseload of members for behavioral health care coordination and or BH case management for persons experiencing severe and persistent mental illness.
- Maintains an active workload in accordance with National Care Manager performance standards.
- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
- Interacts with Utilization department and Physician Advisors to discuss clinical questions and concerns regarding specific cases.
- Coordinates services with state and community programs on behalf of the member, particularly when the member is unable to effectively do so independently
- As a mandated reporter, files and follows-up on reports made to the appropriate government agency (e.g., Adult Protective Services, Child Protective Services, etc.)
- Actively participates in Interdisciplinary Team Meetings and case consultations with Licensed Manager.)
ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
- Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:
Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.
Two ways of working: Hybrid (our default) and office
- Hybrid – In a business unit approved office a few times per year to 3 days per week, on average
- Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.