Behavioral Health Case Manager

Behavioral Health Case Mgr - CT08IE

We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals - and to help others accomplish theirs, too. Join our team as we help shape the future.

Our team is committed to driving profitability by delivering exceptional customer service and superb claim outcomes! The ideal candidate will be part of a dynamic and talented team of Behavioral Health Disability Claim professionals that are committed to conducting comprehensive evaluations of disability claimants' functionality via functional assessments. This position is part of a vast team of Behavioral Health Case Managers who are responsible for the review and evaluation of Short-Term Disability (STD) and Long-Term Disability (LTD) claims. While reviewing cases, our goal is to assess a client's "return to work" potential while also improving their functional capabilities. Successful incumbents in this role will perform functional client assessments and interpret clinical information. They will utilize established clinical guidelines/protocols to facilitate a client's ability to leverage their functional capabilities, work experience and educational background to allow for a safe and productive return to work environment.

Responsibilities:

• Conducts comprehensive evaluation of a disability claimant functionality.
• Advises on highly complex claims at multidisciplinary clinical review roundtables to ensure optimal outcomes.
• Determines when claims contain quality of care issues and escalates these through established channels.
• Independently conferences with treating providers and/or other higher-level facilities to evaluate clinical symptomology present in claimants.
• Leverages resources such as vocational rehabilitation, risk management unit, physician reviews, home assessments, etc.
• Manages risk and resources on highly complex behavioral health claims.
• Identifies appropriate return to work options and/or barriers to partner with internal resources to ensure a smooth transition back into employability and normal activities.
• Reviews clinical integration systems and determines appropriate referral resources to achieve an optimum level of health.
• Supports the leadership team by demonstrating understanding of customer needs and expectations as well as ensuring performance objectives are met.
• Ensures excellent documentation that clearly and concisely communicates focus of functionality vs. impairment and provides a recommendation of support or non-support of clinical findings.
• Collaborates with Ability Benefits Manager and other key players (Vocational Rehabilitation, Consultants, Medical Nurse Reviewers, etc.) for proactive movement of the claim to resolution.
• Manages Short Term Disability (STD) to Long Term Disability (LTD) transition on all behavioral health claims, coordinating with all resources necessary to ensure a seamless process.

• Minimum of 3 years of clinical practice experience following a clinical master's degree.
• Master's Degree required in a behavioral health or mental health discipline.
• License in Behavioral Health Clinical work which may include professional designations in Social Work, Mental Health, Marriage/Family Counseling, etc.
• Professional licenses in: LMHC, LCSW, LMFT, LPC or other similar designations are required.
• A license to practice independently is required.
• Preference for case management and discharge experience.
• Preference for managed care/utilization review/insurance experience.
• Preference for crisis intervention skills.
• Solid technical acumen with Microsoft Office: Word, Excel & PowerPoint.
• Ability to assess and explain complex medical condition.
• Demonstrated aptitude for communicating with attending physicians to identify current workplace limitations or restrictions.
• Accurate clinical assessment and analytical skills.
• Ability to make sound judgments.
• Readily able to accurately document activities.
• Demonstrated desire to learn about the insurance business.

• Negotiation Skills
• Problem Solving
• Plan Development
• Attention to Detail
• Team-Player
• Positive Customer-Focused Approach
• Organizational and Change Management Skills

• This role can have a Hybrid or Remote work schedule. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Scottsdale, AZ, and Alpharetta, GA) will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work schedule, with the expectation of coming into an office as business needs arise.