Position Description This role is dedicated to enhancing medical behavioral integration activities by working directly with members, health plan medical case managers and primary care providers. The focus is to support implementation of Optum's behavioral health intervention model, which directs clinically:appropriate resources towards areas of greatest population risk, and other areas of clinical opportunity. This position will directly support members, health plan case managers, and primary care providers. Additionally, this role will work to improve primary and behavioral heath outcomes by screening and monitoring capabilities, driving best practice behavioral health care within the medical setting, and coordinating with behavioral health specialty care.
Primary Responsibilities:
Member Engagement
Utilize advanced clinical skills to engage and motivate consumers (i.e. members and families) via a recovery, health and wellness:oriented approach
Assist consumers and their families / caregivers with connections to appropriate psychiatric, medical, and psychosocial referrals and services
Identify and remove barriers to procurement, delivery, participation in and success of services
Provide supportive follow:up, monitoring and education as indicated
Partner with designated external providers (including primary care), programs, entities to address the needs, gaps in care, and recovery goals of complex and high risk consumers
Identify and address the needs of members who are consistently high utilizers of services through case conferences and informal communications
Accept referrals via designated processes, collaborate in evaluating available services, and coordinate necessary psychiatric and community referrals, as needed; assist in the development of a relevant and consumer:specific aftercare plan
Contribute to treatment plan discussions; routinely attend clinical rounds and other meetings with medical partners or external entities, when applicable
Provider Engagement
Translate the Optum Behavioral Health model into local market context and practice environments
Educate providers on the Optum Behavioral Health's network, including tele:mental health, and Express Access network providers
Provide guidance on best practices in care coordination, linking patients to Optum resources, community resources and self:management tools
Partner with the Optum Behavioral Health network team to enhance local specialty network and primary care relationships
Collaborates with the payer's network team and primary care clinics to develop interventions to improve behavioral health practice patterns
Serve as the liaison between primary care practices and Optum Behavioral Health to address questions and resolve issues; leverages reports to inform primary care providers of member gaps in car
Required Qualifications:
Masters degree in counseling, psychology or social work AND an active, unrestricted Independent behavioral health license in the state of residence OR; a Registered Nurse (RN) with behavioral health experience
3+ years of experience in a clinical / management role or equivalent managed care experience
Proficiency with Microsoft Office Suite, ability to learn and navigate multiple proprietary software applications; typing proficiency required
Demonstrated familiarity and experience with the current Diagnostic and Statistical Manual and best practice standards for treatment
Preferred Qualifications:
Experience in a medical / behavioral setting (i.e. hospital, managed care organization, or joint medical / behavioral outpatient practice)
Familiarity with collaborative care models
Knowledge and experience with medical terminology desirable
Experience in Primary Care transformation
Dual diagnosis experience with mental health, substance abuse, and medical conditions
Experience working in an environment that requires coordination of benefits and utilization of multiple groups and resources for patients
Clinical training experience
Experience i
