Behavioral Health Case Manager (BHCM) - LCSW, LMHC, – Post-Acute Care

Department: 
Reports To: Director of Operations – Behavioral Health Integration

Position Summary

The Behavioral Health Case Manager (BHCM) is responsible for providing a combination of clinical support, care coordination, and program support within Psych Health Associates’ Behavioral Health Integration program. This role supports medically complex patients across post-acute and long-term care facilities in a defined regional territory.

The BHCM conducts behavioral health assessments, evaluates eligibility for Value-Based Care (VBC) programs, and facilitates coordination between patients, providers, and facility partners. In addition to clinical responsibilities, the BHCM supports the implementation of the Behavioral Health Integration program in their assigned facilities and provides clinical guidance to Behavioral Health Coordinators (BHCs) and interdisciplinary collaboration.

This role requires strong critical thinking skills, proficiency with electronic health records (EHR) and digital communication tools, cultural competence, and strict adherence to compliance and documentation standards. The BHCM collaborates closely with psychiatry, psychology, nursing, therapy departments, social services, facility leadership, and PHA internal operations to support high-quality, relationship-centered behavioral health services.

Key Responsibilities

Clinical Support & Patient Care

• Provide behavioral health support for patients with chronic mental illness, substance use disorders, mood disorders, anxiety disorders, and neurocognitive conditions.
• Conduct Psychiatric Evaluations (intakes) and psychosocial assessments to support diagnostic clarification, treatment planning, and appropriate program placement.
   
   
• Evaluate patients for eligibility across PHA’s behavioral health service lines, including psychiatry, psychology, Behavioral Health Integration, and Value-Based Care programs; obtain informed consent and support ongoing program participation.
• Provide education to patients, families, and facility staff on psychiatry, psychology, and Behavioral Health Integration services to support informed consent, engagement, and appropriate utilization.
• Coordinate referrals into appropriate behavioral health services and ensure timely handoffs across the care continuum.
• Participate in care planning, transitions of care, and patient/family engagement as clinically indicated.

Care Coordination & Facility Collaboration

• Provide secondary support and escalation for cases requiring higher-level clinical review, conflict resolution, or complex care planning.
• Support BHCs in maintaining effective communication with facility administrators, IDT members, families/caregivers, and external providers.
• Maintain accurate, timely, and compliant documentation in the EHR for all BHCM clinical activities.
• Review and support BHC documentation practices to help ensure accuracy, completeness, and alignment with PHA standards and regulatory expectations.

Clinical Support to BHCs

• Support the Behavioral Health Integration program in assigned facilities by providing clinical guidance to Behavioral Health Coordinators (BHCs).
• Provide clinical guidance, mentorship, and field-based support to BHCs to promote consistent performance and professional development.
• Support clinical orientation and competency development for new BHCs as assigned.
• Communicate operational barriers, staffing needs, and program workflow concerns to internal leadership.

Program Performance, Quality & Compliance

• Reinforce compliance with documentation, privacy, billing, and regulatory standards in all BHC and BHCM activities.

• Participate in internal audits, data reviews, and quality improvement initiatives to support program outcomes.

• Identify trends, risks, or gaps in services and communicate findings to the Director of Operations – Behavioral Health Integration, along with recommended actions.

Qualifications

Required

• Active, unrestricted Florida license: LCSW or LMHC
• Master’s degree in Social Work, Counseling, Psychology
• Eligible to bill Medicare for intake assessment services.
• Minimum 3 years behavioral health, case management, or medical social work experience.
• Demonstrated proficiency in behavioral health assessment, DSM-5, clinical documentation, and interdisciplinary communication.
• Ability to travel throughout a designated regional territory; reliable transportation required.
• Proficiency with EHR systems, digital communication tools, and mobile documentation workflows.
• Strong critical thinking, problem-solving, communication, and organizational skills.
• Demonstrated cultural competence and ability to work effectively with diverse populations.

Preferred

• Experience with geriatric or medically complex populations.
• Experience in post-acute, skilled nursing, or long-term care settings.
• Familiarity with CMS Value-Based Care and Behavioral Health Integration models.
• Prior experience supervising field-based or mobile teams.
• Bilingual (e.g., Spanish) preferred but not required.

Physical Demands, Equipment, and Work Environment

• Requires regular travel between facilities within assigned regional territory.
• Must be able to sit, stand, walk, and move within facility environments.
• Requires the ability to lift up to 20 pounds occasionally (e.g., equipment, materials).
• Regular use of laptop, tablet, smartphone, and associated digital tools.
   Work is performed onsite in post-acute, skilled nursing, and long-term care facilities with typical clinical and administrative conditions.