BEACON HEALTH STRATEGIES

CBHI Specialist

JOB DESCRIPTION: Responsible for triaging and managing of members referred to ICC who may be high risk, high utilizing, at significant clinical risk or under-utilizing services. Provide oversight to CBHI  network providers.

PRIMARY RESPONSIBILITIES

1. Manage ICC Members referred by CBHI providers
2. Managing, coordinating care, tracking and reporting of all assigned IICC Members
3. Collaboration with  all CBHI providers
4. Utilization Review for designated ICC clients in Massachusetts for all levels of care
5. Phone coverage as needed on the Urgents Line and for Member Services calls
6. Assist in collection of outcomes information, annual analysis and other reporting and initiatives
7. Telephonic collaboration with  provider and state agencies regarding ICC members and systems meetings as needed
8. Telephonic collaboration with Members and Providers
9. Provider Treatment Record Reviews
10. Attend ICC Individual CarePlanning meetings
11. Other duties as assigned
12. Identify practitioner outliers through analysis of clinical outcomes data, utilization/claims data, complaints, and compliance with care advocacy protocols.
13. Measure improvement of practitioner performance over time.
14. Monitor and report effectiveness of interventions.
15. Modify interventions as appropriate.
16. Interface with other BHS departments including Clinical Care, Network Services, Account Management and Quality Improvement. 

SCOPE: Non-certifications may not be issued on initial review, and always require consultation with a Physician or Psychologist Advisor

EXPERIENCE/EDUCATION:
Specialist are required to be educated in current principles, procedures and knowledge domains of case management, Wraparound and Massachusetts CBHIn services and must be a licensed behavioral health clinician.
A staff providing oversite to CBHI services will have at least one of the following:
• Master’s degree or higher in a health related field and licensure as a behavioral health professional.
•  BSN, licensure as a professional and 3 years behavioral health clinical practice
• Licensed behavioral health clinician/nurse who has Certification as a Case Manager is preferred.

Send Resumes: employment@beaconhs.com