Peer Specialist, Behavioral Health

Summary of Job

Assist the entire BH Care Management interdisciplinary team in managing members with Care Management needs. Ensure work is appropriately documented in the system to effectively implement member care plans. Work seamlessly with clinical staff to ensure member needs are met. Provide telephonic and in-person outreach to members that have been identified for/enrolled in care management and ensure members' needs are supported throughout the duration of member enrollment to the program, by completing screenings with members, coordinating with Care Manager on members' care plan, making appropriate referrals to the interdisciplinary care team, coordinating post-acute services on behalf of members, assisting with community resource needs and more. Perform in-person member visits in community settings, such as their home, Neighborhood Care sites, community agencies,
shelters, hospitals, and physician offices for member engagement.

Responsibilities:

• Work collaboratively, as a critical component of the Medical Management team, to facilitate non-clinical elements of care management, including appointment scheduling and reminders, arranging transportation, and identification of/connection to community based resources.
• Perform accurate and timely intake and data entry for all Care Management requests and referrals for all lines of business, upon receipt of inbound requests, via call, fax, and web portal, in accordance with departmental policy and regulatory requirements.
• Perform member telephonic and in-person outreach for program enrollment and ongoing engagement with the goal of retaining members in the BH Care Management Program.
• Perform in-person member visits in community settings, such as their home, Neighborhood Care sites, community agencies, shelters, hospitals and physician offices to introduce care management programs, validate member contact information, and promote member engagement and retention in the program.
• Triage cases and assign receipts to appropriate teams.
• Communicate and/or respond to inquiries from providers, facilities, and members.
• Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines.
• Enter and maintain documentation in electronic record, meeting defined timeframes and performance standards.
• Perform other related projects and duties as assigned.
• Manage caseload and update care plans for low and moderate risk members in collaboration with the clinical team.
• Support care interventions including making doctor's appointments, health coaching, referrals to internal and external resources, assist with transportation issues.
• Identity and address needs for Transitions of Care.
• Leverage motivational interviewing skills and a member-centric approach to identify members' needs, prioritize and support care plan implementation.
• Perform a wide range of research and educational outreach activities to encourage healthy behaviors, such as outreaching to identified members who need a primary care provider or who may have gaps in care related to recommended tests or provider visits and facilitate gap closure and receipt of evidence-based care.
• Adhere to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
• Support communication and coordination with delegated entities, as necessary.
• Coordinate directly with community-based organizations and agencies to identify available and/or alternative resources for a wide range of concerns, including home safety, financial assistance, caregiver support and transition assistance.
• Actively participate in assigned committees and projects.
• Additional tasks and duties as required.