Supporting utilization management functions for more complex and non-routine cases as needed.
Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs.
Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits.
Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation.
Perform case management activities in community settings including face to face with members as required.
Requirements
Current, active unrestricted Tennessee license in Nursing (RN) or behavioral health field (Master's level or above) (Ph.D., LCSW/LMSW, LLP, MHC, LPC, etc.) required
3 years
Clinical behavioral health / substance use disorder experience required
1 year
Must be knowledgeable about community care resources and levels of behavioral health care available.
Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
Experience with Motivational Interviewing Techniques and Adult Learning Styles