Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job assures that pediatric members and their families with medical and psychosocial needs have access to high quality, cost-effective health care. This role supports pediatric members and their families through motivational enhancement by developing goals, self-management skills and behaviors that impact well-being and lifestyle changes. The incumbent will also encourage engagement in low intensity interventions. This is accomplished by assisting in the initial screening, identifying gaps in care and barriers to adherence, goal setting, planning, arranging, coordinating, necessary to facilitate member access to healthcare services and community resources. Conducting accurate planning, and collaborating with internal and/or external customers and contacts. Following established regulatory guidelines, policies, and procedures in relation to member interventions and documentation of activities related to the member’s care and progress across the continuum of care. Facilitating and/or participating in interdisciplinary and/or interagency meetings, when necessary, to facilitate coordination of services/resources for members. The overall goal is to help members navigate the health care system and develop condition self-management skills through behavior change.

ESSENTIAL RESPONSIBILITIES

• Communicate effectively while performing customer telephonic motivational interviewing with external contacts. Educate members in order to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes including health behavior changes.

• Collaborate with Case Management Specialists, Management Team, Physician Advisors, Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers with the goal being to coordinate member care.

• Collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs. Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services.

• Attend and participate in required meetings, interagency and/or interdisciplinary team meetings, including staff meetings, internal rounds, and other in-services in order to enhance professional knowledge and competency for overall management of members. Participate in departmental and/or organizational work and quality initiative teams. Attend internal and external continuing education forums annually to enhance overall clinical skills and maintain professional licensure, if applicable.

• Educate health team colleagues of the role and responsibility of Case Management and the unique needs of the populations served in order to foster constructive and collaborative solutions to meet member needs.

• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Psychology, Social Work Health Education or other Human Services related field.

Substitutions

• 6 years of related and progressive experience in the Behavioral Health field in lieu of Bachelor's Degree.

Preferred

• Master's Degree in Psychology, Social Work, Counseling, Marriage and Family Therapy,, Health Education or other Human Services related field.

EXPERIENCE

Required

• 3 years experience in Behavioral Health and/or Substance Use roles.

Preferred

• Prior experience with pediatric population

• Prior experience in a managed care setting

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• Board Certified Coach

SKILLS

• Ability to manage critical conversations

• Effective communication skills (listening, verbal and written)

• Comfort in leading one-on-on conversations while practicing clinical and motivational interviewing skills

• Capacity to work under pressure

• Ability to identify risk and gaps in care

Language (Other than English):

Bilingual Preferred

Travel Requirement:

0%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Remote

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$17.93

Pay Range Maximum:

$32.26

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J238002