Registered Nurse (RN) - Case Manager, Behavioral Health
Leon Health
Miami, FL

Manager of Behavioral Health Case Management (RN)

Leon Health is looking for a Behavioral Health Manager to oversee the day-to-day operations within the HMO. Under the general supervision of the Director of Health Services, the position is responsible for overseeing the daily operations of the behavior health case management department and its ongoing assessment, planning, and evaluation of the members within the behavioral health care management program. The Behavior Health Manager will be accountable for understanding all aspects of the Leon Health Care Management Program. ESSENTIAL DUTIES AND RESPONSIBILITIES 1. Develops, educates, and manages clinical and non-clinical staff within the guidelines of Leon Health's policies and procedures to assure competencies which are appropriate to accomplish duties and responsibilities productively and efficiently. 2. Oversees the goal setting process and regularly reviews performance of direct reports, addressing performance and conduct issues when needed. 3. Responsible for MOC activities, including HRA, individualized care plan, interdisciplinary care team and care transitions 4. Manage D-SNP members, in particular those belonging to the most vulnerable population 5. Identify needs and create a care plan, with the input of the member's interdisciplinary care team, to help the member achieve their goals 6. Completes BH assessments with member/caregiver/provider to obtain information regarding client status, functional, cognitive capabilities, support system and need for services 7. Support ongoing member engagement 8. Address the member's individual needs, strengths, preferences, and goals 9. Educate members on their conditions and promote self-management skills including the understanding signs and symptoms that indicate a need to contact the PCP, and when it is appropriate to seek urgent or emergent care 10. Support medication adherence CERTIFICATES, LICENSES, REGISTRATIONS * Certified Behavioral Health Case Manager (CBHCM) * State of Florida RN license QUALIFICATIONS * Knowledge of Centers for Medicare and Medicaid Services (CMS), Florida Medicaid, NCQA, and AAAHC policies and procedures * Knowledge of Dual Eligible Special Needs Plans * Knowledge of Managed care and healthcare industry and practices * Understanding of BH Case Management best practices * Understanding of medical necessity for appropriate patient status and level of care WORK EXPERIENCE * Management experience * Minimum 2-5 years of experience in BH Case Management * Medicare and/or Medicaid managed care experience