Behavioral Health Program Manager, RN

Behavioral Health Program Manager, RN 3.9 3.9 out of 5 stars 3250 Lacey Road, Downers Grove, IL 60515 $75,000

• $95,000 a year
• Full-time Passionate Care Management LLC 43 reviews $75,000
• $95,000 a year
• Full-time Position Summary The Behavioral Health Integration (BHI) Program Manager, RN is responsible for managing the BHI Chronic Care Program as well as delivering and documenting services in full compliance with Centers for Medicare & Medicaid Services (CMS) Behavioral Health Integration requirements, and related psychiatric collaborative care models where applicable.

This role will oversee the operations of the BHI program as well as ensuring the clinical compliance requirements are being followed. Including; documentation, consent, care planning, and time-tracking requirements, to support compliant billing, audit readiness, and high-quality patient care within a primary care setting. The role plays a critical role in driving compliant revenue generation, clinical quality, and scalable program growth within the BHI model. This role is critical in ensuring accurate patient identification, documentation integrity, time capture, and monthly billing eligibility while delivering high-quality integrated behavioral health support. The BHI Nurse directly supports sustainable recurring revenue through structured workflows, compliant service delivery, and outcome-driven patient engagement. Core Responsibilities 1. Program Management Support the development of the BHI Care Program, including developing operational strategies and requirements. Develop workflows, performance indicators and metrics. Effectively coordinate and facilitate communications with physicians, consultants, community Behavioral Health providers, and staff members. Ensure all compliance requirements are met and followed. 2. Patient Eligibility & Consent (CMS Required) Identify Medicare beneficiaries with behavioral health conditions appropriate for BHI services. Confirm the presence of at least one behavioral health condition impacting overall health. Obtain and document verbal or written patient consent per CMS requirements prior to service initiation. Ensure the patient understands cost-sharing responsibilities. Ensure no overlap conflicts with CCM, PCM, or other care management services unless allowed. Maintain active monthly patient panel to meet productivity benchmarks. 3. Initial Assessment & Care Plan Development Conduct or assist with behavioral health assessments and administration of validated screening tools (PHQ-9, GAD-7, etc.) Collaborate with the treating provider to develop and document an individualized care plan, including; measurable treatment goals, establishing planned interventions and document coordination strategy Core Responsibilities 1. Program Management Support the development of the BHI Care Program, including developing operational strategies and requirements. Develop workflows, performance indicators and metrics. Effectively coordinate and facilitate communications with physicians, consultants, community Behavioral Health providers, and staff members. Ensure all compliance requirements are met and followed. 2. Patient Eligibility & Consent (CMS Required) Identify Medicare beneficiaries with behavioral health conditions appropriate for BHI services. Confirm the presence of at least one behavioral health condition impacting overall health. Obtain and document verbal or written patient consent per CMS requirements prior to service initiation. Ensure the patient understands cost-sharing responsibilities. Ensure no overlap conflicts with CCM, PCM, or other care management services unless allowed. Maintain active monthly patient panel to meet productivity benchmarks. 3. Initial Assessment & Care Plan Development Conduct or assist with behavioral health assessments and administration of validated screening tools (PHQ-9, GAD-7, etc.) Collaborate with the treating provider to develop and document an individualized care plan, including; measurable treatment goals, establishing planned interventions and document coordination strategy.

• Care Plans Must Include
• Behavioral health diagnosis Treatment goals Symptom monitoring plan Medication management coordination Planned follow-up schedule 4.

Ongoing Monthly Monitoring (Time-Based Compliance) Provide at least 20 minutes of clinical staff time per calendar month . Accurately track and document cumulative time spent on care coordination, patient communication, treatment monitoring, medication adherence follow-up, provider collaboration. Document start/stop times or cumulative tracked minutes per month. Ensure services are not duplicated with other care management programs unless permitted. 5. Psychiatric & Provider Collaboration Facilitate communication between Primary Care providers, Psychiatric consultant(if applicable), and community behavioral health providers Document all collaborative care activities. Escalate urgent clinical findings immediately. 6. Documentation Standards (Audit-Ready) Develop and maintain documentation standards. Ensure EHR documentation supports medical necessity. Maintain compliance with CMS billing regulations and payer policies. Participate in internal compliance reviews and audits.

• Documentation must include
• Date of service Nature of services provided Clinical relevance Time spent Updates to care plan Outcome measures 7.

Quality & Outcome Monitoring Track validated outcome scores over time. Document measurable improvement or clinical justification for continued services. Support value-based care metrics and HEDIS-related quality measures where applicable. 8. Structured Monthly Workflow Execution Execute standardized PRG BHI workflow including: monthly patient outreach cadence, symptom reassessment using validated tools, care plan review and modification and medication adherence checks. Ensure minimum 20 minutes per patient per calendar month is met and documented. Maintain consistent patient engagement to prevent revenue leakage. 9. Panel Management & Productivity Manage assigned patient panels to meet revenue targets. Monitor active vs. inactive patients, drop-off rates, and missed monthly thresholds. Re-engage patients proactively to preserve continuity and recurring billing eligibility. 10. Interdisciplinary Revenue Collaboration Work closely with billing department, compliance team, providers and Psychiatric consultants. Address documentation gaps before claim submission. Participate in revenue optimization meetings. 11. Outcome & Value-Based Performance Track clinical improvement trends. Contribute to reduced hospitalizations and ER visits. Support value-based contract performance. Demonstrate measurable patient engagement metrics. Qualifications Required Active RN license in good standing. Minimum 2 years clinical experience. Experience in behavioral health or integrated care. Strong knowledge of CMS BHI billing and documentation requirements. Proficiency in time tracking and EHR documentation for compliance. Preferred Multi-state licensure a plus! Clinical or Chronic Care program management. Role Performance Indicators 100% documented consent prior to billing. 100% compliance with monthly minimum time requirements. Zero unsupported claims in internal audits. Accurate and timely documentation. Demonstrated improvement in patient outcome scores.

Job Information Time Type:

Full-time Location:

On-site (potential for hybrid)

Compensation:

$75,000

• 95,000

Pay:

$75,000.00

• $95,000.

00 per year

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Referral program Vision insurance Application Question(s): Do you hold any licensure outside of IL? Do you have experience managing clinical or Chronic Care Programs?

Experience:

Clinical Care:

2 years (Required)

Behavioral Health Integrated Care:

2 years (Required)

BHI Billing:

2 years (Required) EHR systems: 2 years (Required)

Medicare Compliance:

2 years (Required)

License/Certification:

RN License (Required) Ability to

Commute:

Downers Grove, IL 60515 (Required)

Work Location:

In person