Company Description

Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities.

We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.

Position Responsibilities

Specific

• Manage expenses, facilitate access and improve quality of life for persons with long-term chronic conditions and/ or high risk, high cost disease states (Disease and/ or Chronic Condition Management)
• Work with patients in distinct populations and sub-populations to promote global outcomes, optimize health, manage care and control costs (Population Health)
• Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination, case management
• Educate member/caregivers about treatment options, community resources, insurance benefits, etc
• Engage member to complete health and psychosocial assessment, taking into account the cultural and linguistic needs of each member
• Assess, develop, implement, document, coordinate, monitor, manage, evaluate and update comprehensive individualized care plans (ICP) designed to provide evidence based care to meet member needs
• Employ ongoing assessment and documentation to evaluate member response to and progress on the ICP
• Identify and manage barriers to achievement of care plan goals
• Identify and implement effective interventions based on clinical standards and best practices
• Collaborate with members of an inter-disciplinary care team (ICT) to identify member needs and opportunities that would benefit from care coordination to achieve goals and maximize member outcomes
• Act as a liaison to collaborate with facility based case managers, provider and care transition/ discharge planners to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner
• Coordinate with community-based case managers, service providers and community resource agencies to ensure coordination and avoid duplication of services
• Appropriately terminate care coordination services based upon established case closure guidelines
• Provide clinical oversight and direction to unlicensed team members as appropriate

General

• Conduct comprehensive behavioral health assessments to identify member needs, barriers to care, social determinants of health, and opportunities for intervention
• Develop, implement, and monitor individualized, member-centered care plans in collaboration with members, caregivers, providers, and interdisciplinary teams
• Coordinate behavioral health services across the continuum of care, including inpatient, outpatient, community-based, and substance use treatment settings
• Facilitate transitions of care following hospitalizations, emergency department visits, residential treatment, and other significant care events
• Engage members through outreach, education, motivational interviewing, and ongoing care coordination activities to promote treatment adherence and positive health outcomes
• Collaborate with behavioral health providers, primary care providers, community organizations, and health plan teams to address identified care gaps and support whole-person care
• Identify and address social determinants of health, including housing, food insecurity, transportation, and access to community resources
• Monitor member progress toward established goals and update care plans as appropriate
• Maintain timely and accurate documentation in accordance with health plan requirements, state and federal regulations, and NCQA standards
• Support quality improvement initiatives through identification of care gaps, trends, barriers to engagement, and opportunities to improve member outcomes
• Participate in interdisciplinary case conferences, care coordination meetings, and other health plan initiatives as required
• Maintain current knowledge of behavioral health best practices, community resources, and state and federal regulations impacting care management services

Competencies

Position Qualifications:

• Ability to translate member needs and care gaps into a comprehensive member centered plan of care
• Ability to collaborate with others, exercising sensitivity and discretion as needed
• Strong understanding of managed care environment with population management as a key strategy
• Strong understanding of the community resource network for supporting at risk member needs
• Ability to collect, stage and analyze data to identify gaps and prioritize interventions
• Ability to work under pressure while managing competing demands and deadlines
• Well organized with meticulous attention to detail
• Strong sense of ownership, urgency, and drive
• The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families.
• Excellent analytical-thinking/problem-solving skills.
• The ability to work effectively in a fast-paced environment with frequently changing priorities, deadlines, and workloads.
• The ability to offer positive customer service to every internal and external customer

Experience

• Licensed Clinical Social Worker (LCSW or LMSW) in Michigan
• Minimum of 2 years in behavioral health care management in a managed care setting
• Familiarity with public sector populations (Medicaid, Medicare, Duals, etc.) and experience working with individuals with serious mental illness (SMI), substance use disorders (SUD), or co-occurring conditions

Physical Requirements

• Must be able to sit in a chair for extended periods of time
• Must be able to speak so that you are able to accurately express ideas by means of the spoken word
• Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices
• Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse
• Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types
• Must be able to fluently communicate both verbally and in writing using the English language
• Must be able to engage in continuous social interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously

Time Zone: Eastern or Central

Other Information

• Expected Hours of Work: Monday - Friday 8a.m. – 5 p.m.; with ability to adjust to Client schedules as needed
• Travel: May be required, as needed by Client
• Direct Reports: None
• Salary Range: $50,000 - $80,000

EEO Statement

It is Clearlink Partners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.