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Manager overseeing medical review processes for Medicare claims at BlueCross BlueShield of South Carolina. Ensuring compliance with standards and laws while driving continuous improvement in claim processing.
About the role
- Behavioral Health Case Manager at Vynca coordinating care for individuals with complex needs in California. Engaging with clients, healthcare providers, and community services in a hybrid setting.
Responsibilities
- Assess member needs in the areas of physical health, mental health, SUD, oral health, palliative care, memory care, trauma-informed care, social supports, housing, and referral and linkage to community-based services and supports
- Oversees the development of the client care plans and goal settings
- Offer services where the member resides, seeks care, or finds most easily accessible, including office-based, telehealth, or field-based services
- Connect clients to other social services and supports that are needed
- Advocate on behalf of the client with health care professionals (e.g. PCP, etc.)
- Utilize evidence-based practices, such as Motivational Interviewing, Harm Reduction, and Trauma-Informed Care principles
- Conduct outreach and engagement activities to facilitate linkage to the ECM program and log activity in the Client Relationship Management (CRM) system
- Evaluate client’s progress and update SMART goals
- Provide mental health promotion
- Arrange transportation (e.g., ACCESS)
- Complete all documentation, including outcome measures within the timeframes established by the individual care plans
- Maintain up-to-date patient health records in the Electronic Medical Record (EMR) system and other business systems
- Complete monthly reporting to ensure program compliance
- Attend training as assigned
Requirements
- Active, unrestricted ACSW, LCSW, LMFT, or LPCC license in California required
- 1+ year of experience as a care manager, care navigator, or community health worker supporting vulnerable populations. 2 or more years preferred.
- Willing and able to work Monday-Friday 8:30am-5:00pm, both in the field and remotely, with flexibility for potential evenings and weekends.
- Working knowledge of government and community resources related to social determinants of health
- Excellent oral and written communication skills
- Positive interpersonal skills required
- Clean driving record, valid driver's license, and reliable transportation
- General computer skills and a working knowledge of Google Workspace, MS Office, and the internet
- Bilingual (English/Spanish) preferred
Benefits
- medical, dental, and vision insurance
- income protection benefits
- flexible PTO
- company holidays
- 401k
- access to other wellness benefits
- mileage reimbursement will be provided per IRS guidelines
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