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Child Mental Health Specialist

POSITION PURPOSE:
Child Mental Health Specialist is responsible for care coordination and health education with identified Apple Health Medicaid enrollees. Completes assessments of enrollees and with Member participation, develops a comprehensive care plan. Primary goals include closing gaps in preventive care, addressing barriers and supporting the enrollee’s self-management of chronic illness. The Care Management Clinician collaborates and facilitates care with care providers, community resources and caregivers to provide additional support. Particularly high risk, complex members are followed by face-to-face interactions in their community; including hospitals, provider offices, home or designated meeting places and other health care facilities.

PRINCIPAL DUTIES:
• Conduct comprehensive assessments that include the medical, behavioral, pharmacy and social needs of the Member. Review existing claims data and documentation as appropriate, and identify gaps in care based on clinical standards of care.
• Arranges, coordinates and monitors multiple services from different providers to serve client needs with state and local social service agencies and nonprofit organizations.
• Oversees behavioral health services requested for enrollees under age twenty one (21) and conducts an assessment of client/caregiver psychosocial needs and coordinates appropriate services.
• Serves as the behavioral health Children’s System Administrator, including participating in designated committees such as the Children’s Long Term Inpatient Program (CLIP).
• Provides or oversees care management services in a culturally competent manner that addresses health disparities by interacting directly and in-person with the enrollee and his or her family in the enrollee’s primary language with appropriate consideration of literacy and cultural preference.
• Engages enrollees in development of a strengths-based individualized plan of care, in collaboration with their primary care provider that addresses needs, concerns, gaps in care and seeks to reduce unnecessary ER utilization and hospital readmissions.
• Coordinates and modifies the care plan with the enrollee, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan /system departments as appropriate.
• Identifies Members who are high risk for readmission and provides hospital visits and follow up home visits to those Members as well as those who stratify as super–users.
• Supports compliance with CHPW’s Apple Health Contract with the Health Care Authority for Fully Integrated Managed Care as related to care coordination requirements.
• Supports compliance with NCQA accreditation standards.
• Works collaboratively with the team on day-to-day activities and collaborates on priorities with the Supervisor of Care Management.
• Works collaboratively with other departments and operations teams including Utilization Management and care management sub-contractors.
• Ensures that the Supervisor of Care Management is made aware of any potential risk management issues in a timely manner.
• Participates in interdisciplinary team clinical supervision, presenting a clinical and social history, healthcare resource utilization plan, case management interventions and barriers to success.
• Ensures case documentation is consistent with policy and procedures.
• Other duties as assigned.

OTHER ESSENTIAL FUNCTIONS:
• This position involves traveling on behalf of the Company. It is essential that a current driver’s license, proof of insurance and an acceptable driving record are maintained.

QUALIFICATIONS:
Education, Licensure and Certification:
• Bachelor’s degree in a physical or behavioral health field or related healthcare licensure required.
• Independent, unrestricted licensure within Washington State as a social worker, Registered Nurse, Licensed Practical Nurse or other behavioral health practitioner required.
• Meets or exceeds the definition for Child Mental Health Specialist as defined by WAC 388-865-0150.

Prior Related Experience:
• Experience with both physical and behavioral health services desired.
• Minimum three years clinical experience working directly with patients/Members in an acute care or relevant setting with evidence of the ability to make sound clinical judgments about both children and adults.
• Case Management Certification desired; all Care Management Clinicians are encouraged to pursue Integrated Medical Behavioral Case Management certification.
• Experience and familiarity with at-risk populations, communities of color and local resources for persons with behavioral and/or physical health needs highly desired.
• Minimum one year experience in a managed care setting desired.

Employment Eligibility:
• Candidate has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.

Knowledge, Skills, and Abilities:
• Proficient in Microsoft Office products (Word, Excel, PowerPoint and Outlook).
• Experience using a health plan care management system or electronic medical record system.
• Excellent planning, organizational, communication, analytical skills.
• Excellent verbal and written communication skills.
• Works well with others in a collaborative and respectful manner.
• Able to multi-task, deal with complexity on a frequent basis.
• Performs all functions of the job accurately and in a timely manner.
• Able to work under pressure and time constraints.

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Time:  Full time
Salary:  Salary
Category:  Clinical/pharmacy/quality

Updated: 1/9/2017 2:26:00 PM