Job description

Position Title: Behavioral Health Care Coordinator (RN's, Psychologists or Social Workers only need to apply)

Department: Care & Population Health Management

Reports To: Behavioral Health Manager

Status: Full Time Exempt

Hours: Monday – Friday

Supervision: This position does not supervise any other staff

Date Updated: October 17, 2022

Summary: PrimeWest Health care coordinators are responsible for implementing a care management program that focuses on improving the health of individual PrimeWest Health members and their communities while reducing health care costs through coordination of health and wellness services provided by PrimeWest Health’s contracted health care providers.

The Behavioral Health Care Coordinator supports county and internal PrimeWest Health staff in the area of behavioral health, which includes mental health and substance use disorder (SUD). This individual fosters collaborative relationships with county partners and mental health and special needs providers. This position assists with developing and implementing best practices and goals and analyzing outcomes for members receiving behavioral health care management and is responsible for audits in the areas of targeted case management and SUD. This individual collaborates with PrimeWest Health care coordinators and county case managers to improve care throughout the health care continuum. This position is also responsible for implementing the Restricted Recipient Program (RRP) according to statutory and contract requirements. Eighty percent of this position’s time is dedicated to direct member contact and coordination of member benefits.

A. Reporting Accountability

This position is responsible for meeting the following regulatory, contractual, or other requirements on behalf of PrimeWest Health:

• Knowledge of Minnesota Department of Human Services (DHS), Centers for Medicare & Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA) requirements
• Knowledge of the following DHS programs and contracts: Families and Children, Special Needs BasicCare (SNBC), and Minnesota Senior Health Options (MSHO)/Minnesota Senior Care Plus (MSC+)
• Shared responsibility for ensuring compliance with all CMS, DHS, and NCQA rules and regulations in assigned area of responsibility

B. Role and Key Responsibilities
Assist the Behavioral Health Manager and PrimeWest Health staff in the following as needed:

1. Assess the individual and aggregate behavioral health, mental health, and substance use status of members

2. Coordinate individual member treatment plans with a multi-disciplinary team to ensure appropriateness, quality, and cost-effectiveness of services provided to members

3. Monitor effectiveness of treatment plans

4. Collaborate with county agencies to achieve community behavioral health improvement goals

5. Assist in designing and fully implementing the PrimeWest Health behavioral health care management model

6. Develop and implement the Behavioral Health Education program for members

7. Assist in developing and implementing continuous behavioral health care coordination and quality improvement plans

8. Conduct care management training sessions on behavioral health

9. Attend and collaborate with community, regional, and state-wide initiatives as they relate to behavioral health and the RRP

10. Conduct monthly monitoring with follow-up regarding utilization management pertinent to behavioral health

11. Participate in PrimeWest Health behavioral health initiatives, collaboratives, and local advisory committees when requested

12. Implement the care management model through telecommunication and direct interaction

13. Staff appropriate committees as assigned

14. Demonstrate knowledge of quality improvement processes and data interpretation

15. Perform member and provider notification/education, including updating the PrimeWest Health Provider Manual

16. Collaborate with other care coordinators and Member & Provider Services staff

17. Assist members with treatment access, outcomes, discharge planning, and post-discharge follow-up. In addition, provide support and education to members post-discharge to encourage healthy lifestyles and provide referrals for additional services when needed.

18. Perform quality and compliance audits as required for targeted case management and substance use treatment providers based on MN Stat. Chap. 254A and 254B, MN Stat. sec. 245.462 and 245.4871, Title 42 Code of Federal Regulations (CFR), MN Rules Chap. 9530, and NCQA standards

19. Develop, monitor, and update appropriate PrimeWest Health policies and procedures

20. Conduct utilization management responsibilities for all Service Authorization/notification requirements and denial, termination, or reduction of services for behavioral health populations. This includes Intensive Residential Treatment Services (IRTS), Assertive Community Treatment (ACT), Adult Rehabilitative Mental Health Services (ARMHS), Behavioral Health Home, Rule 5, Mental Health Targeted Case Management (MH-TCM) for children and adults, and SUD assessments and treatment services.

C. General PrimeWest Health Responsibilities

1. Abide by the PrimeWest Health Code of Conduct

2. Comply with all PrimeWest Health policies and procedures

3. Comply with the Health Insurance Portability and Accountability Act (HIPAA) and all other privacy laws

4. Be familiar with building safety procedures and alert maintenance if something requires attention

5. Keep public areas of the department and office neat and clean

6. Conduct other responsibilities and activities as needed and assigned

D. Professional Competencies

1. Practice knowledge of clinical standards and outcomes

2. Organizational and time management skills; ability to work effectively with minimal supervision and structure

E. Educational Requirements and Required Qualifications

1. At minimum, a BS with preferred expertise in assigned area of responsibility. Must have current/prior knowledge of working with waiver services and county structure related to this population.

2. Demonstrated knowledge of, and proficiency in, Word, Excel, and Outlook required.

3. Flexibility and ability to handle multiple tasks. Demonstrated organizational skills and attention to detail. Ability to work effectively with a variety of people both within and outside of the organization. Excellent verbal and written communication skills.

4. Ability to sit at a desk or computer station most of the time. Ability to occasionally lift and/or carry such articles as file folders and small boxes up to 30 pounds. Some travel, including overnight travel, required.

F. Appropriate Licensure and Certification Requirements

1. Preference for current and unrestricted alcohol and drug counselor license (Minnesota certification preferred), current and unrestricted social worker license in the State of Minnesota, or current and unrestricted registered nurse (RN) license in the State of Minnesota. Experience working with individuals with behavioral health concerns considered in lieu of licensure.

2. Must attend continuing education sessions each year to support license requirement, if applicable

G. Collaborative Efforts with Other Departments

1. Administrative Services

2. Business IT & Claims Administration

3. Corporate Compliance & Auditing

4. Information Systems & Technology

5. Member & Provider Services

6. Quality & Utilization Management

H. Supervision – N/A

This position description is not to be construed as an exhaustive statement of essential functions or responsibilities.

Alexandria, Minnesota – This position offers the possibility for remote or hybrid work

PrimeWest Health will accept résumés for this position until filled. No phone inquiries please. Employment to begin as soon as possible.

Qualified candidates should submit their résumé and cover letter to:

Attn: Donna Meyer, Director of Care & Population Health Management
PrimeWest Health

3905 Dakota St

Alexandria, MN 56308

Job Type: Full-time

Pay: $60,000.00 - $72,000.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Work Location: In person

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