Description: Job Summary:
Collaborates with Chief Physicians, staff physicians and managers/care providers from multiple disciplines/departments to manage the planning, development, implementation/ delivery and evaluation/improvement of a disease management program for at-risk patients in a behavioral healthcare  population defined by a chronic psychiatric disease state or disorder such as, but not limited to, characterological disorders/conditions, depressive, anxiety and/or personality disorders, dual diagnosis, substance addiction, autism.

Essential Responsibilities:

Responsible for coordinating an integrated systematic care management process/ program based on clinical pathways, protocols and guidelines.
Such program directs the member/patient to appropriate and timely specialty diagnostic and treatment care services across the full continuum of care.
Provides comprehensive on-going care management that meets established standards/ benchmarks for efficiency, improved clinical outcomes, quality, resource utilization, cost effectiveness, evidence-based treatment plans and improves members quality of life and satisfaction.
In the program planning/development stage, acts as project manager to develop a strategic/business plan which meets access, cost, quality and member/patient satisfaction goals and needs.
Utilizes a multi-disciplinary team approach/process to develop and implement clinical pathways and care management interventions.
Identify and stratify at-risk patient populations.
Analyze practice patterns/variations.
Establish care/treatment benchmarks.
Design a disease care model for analyzing disease components and interventions which addresses all components of patient care including patient self-management, education/teaching, and stratified interventions based on illness severity and co-morbidities.
Pilot tests new and administers/communicates on-going program in conjunction with Chief Physicians and care providers/managers.
Manages disease-specific data collection, analysis, and reporting based on financial, clinical, utilization, cost, best practices, and baseline metrics.
Problem solves program issues and treatment variations.
Analyzes program outcomes actually achieved vs intended outcomes.
Monitors and resolves program compliance issues involving providers and patients.
Evaluates disease management program in terms of utilization review/resource issues such as treatment variances, goal achievement of interventions, effective interaction between all clinicians/providers, appropriateness of program care model, quality improvement and patient/member satisfaction.
Conducts analyses related to protocol/treatment plan compliance as well as clinical, quality, communication, financial/cost outcomes and makes recommendations for program revisions.
Monitors, evaluates and improves patient access provided by care managers via telephone and other means in order to improve patient self-care/management, compliance and participation in care processes.
Acts as organization liaison with relevant community agencies, organizations and task forces. Basic Qualifications:
Experience

Minimum four (4) years of behavioral health case management experience in a relevant chronic disease in an acute medical center, OR
Minimum four (4) years of experience analyzing/improving  behavioral health care clinical practices/processes and clinical performance in an acute medical center.

Education

Masters degree in clinical social work from an institution accredited by the Council on Social Work Education

License, Certification, Registration

Licensed Clinical Social Worker (California)

Additional Requirements:

Ability to conduct and utilize processes, principles and practices of program evaluation and case management modalities/interventions.
Demonstrated knowledge of human development and psychotherapeutic theories/principles and practices.
Ability to utilize project management skills and abilities, as well as consulting and interpersonal skills ( communication, influencing, negotiating, persuasion).
Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

N/A.

Notes:

• LCSW New Position for Primary Care Plus Program.