Health specialist - pediatric

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job provides case and condition management services to Pediatric members with behavioral health concerns. The incumbent uses clinical and motivational interviewing skills to assess members' needs and establish mutually agreeable short and long-term goals. Supports members in developing self-management skills and adopting positive behavior changes, identifies and addresses barriers to member's adherence to standards of evidence-based care, helps members to coordinate their healthcare services and navigate the healthcare system, and identifies on-line, telephonic and community-based resources.

ESSENTIAL RESPONSIBILITIES

• Function as a primary contact for members with behavioral health needs with the depth of engagement ranging from coaching interventions to intensive case management interventions. The overall goal is to help members navigate the health care system and develop condition self-management skills through behavior change. Provide members with resources and tools to assist in health-related decision making. Conduct telephonic clinical and psycho-social assessments that address the health and wellness needs of the Organization's members.

• Develop case or condition-specific plans of care using the clinical information system to establish short and long-term goals. Establish a plan for regular telephonic contact with each member to review progress and assess the potential for additional needs.

• Communicate with the member's treating provider or providers in more complex clinical situations requiring case management intervention.

• Identify on-line, telephonic and community-based resources that can assist the member to achieve and maintain their personal health goals and assists the member to access those services.

• Pro-actively incorporate lifestyle improvement and prevention opportunities into member interactions and coaching.

• Ensure that all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.

• Collaborate with case and condition management teams to provide co-management activities for members who require additional services. Participate in ongoing training and educational activities related to behavioral health and medical topics.

• Other duties as assigned or requested.

EDUCATION

Required

• High School Diploma/GED with RN license or Master's Degree if licensed Behavioral Health Professional

Substitutions

• None

Preferred

• If Registered Nurse (RN), BSN or MSN preferred

EXPERIENCE

Required

• 3 years of post-licensure experience in any combination of behavioral health clinical, case management and/or condition management.

Preferred

• Pediatric behavioral health experience

• Direct experience supporting Pediatric behavioral health programs

• Advanced training and experience in cognitive behavioral therapy (CBT) and motivational interviewing

• Experience working with the healthcare needs of diverse populations

• Proficiency in a second language

LICENSES AND CERTIFICATIONS

Required

Any of the following:

• Registered Nurse (RN)

• Licensed Social Worker (LSW)

• Licensed Clinical Social Worker (LCSW)

• Licensed Master Social Worker (LMSW)

• Licensed Professional Counselor (LPC)

• Licensed Mental Health Counselor (LMHC)

• Licensed Marriage and Family Therapist (LMFT)

• PhD

Preferred

• Case Management Certification

SKILLS

• Proficiency in utilizing PC-based system application and reporting packages, especially Microsoft Office application

• Excellent verbal and written communication skills as well as the ability to manage multiple priorities in a rapidly changing environment

• High degree of organizational skills

• Ability to interact with group employer accounts and other stakeholders relative to behavioral health topics

• General understanding of employer-based and individual insurance products

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

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:

$57,700.00

Pay Range Maximum:

$107,800.00

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 any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at [email protected]

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Req ID: J271363