A day in the life of a Carelon Behavioral Health transitional case manager

“I work with people experiencing behavioral health diagnoses, some of whom also struggle with comorbidities. My caseload includes about 100 members,” says Michael Romero, Health Coordinator, Carelon Behavioral Health. “I support individuals experiencing frequent hospitalizations, working to get them reintegrated into society. I support them after they’ve been discharged, providing them resources to keep them with out of the hospital.”
 

What is your job like?

Romero provides follow up, helping to coordinate ongoing care. “I assist members with many issues. I explore what types of ongoing needs they’ll have when they’ve been discharged. I find out if they need a primary care provider, medication and counseling, or treatment for substance use disorders. I talk to them about what type of living arrangements they are returning to, if they are homeless, or if they are in an abusive relationship. I try to get a sense of what kinds of supports they have, if any, because people in crisis often don’t have that.”

He stresses how members need to be ready to make life changes before he can help them. “My goal is to intervene if a member gets rehospitalized. I ask them if they are ready to make different choices. I try to get through to them that they need treatment to get out of the rehospitalization cycle and create a new outcome.”

Romero uses a person-centered approach when working with members. “They will get into treatment when they are ready, when they are tired of conflicts with the law, and being in and out of the hospital.”
 

The 7-day mark

He contacts a member within seven days of their discharge, even if he needs to get creative in finding them. “If people can make the seven-day mark without being re-hospitalized, they are likely to make it to the 30-day mark. Contacting members can be challenging, however, as some members may not have a phone, and other may be in shelters. So if necessary, I will track them through claims if I can’t find them any other way.”

Once members have passed the 30-day mark, Romero works with them on learning coping skills to offset psychiatric symptoms and become higher functioning. He also assists members with more immediate needs. “In addition to helping them find primary care providers, I help coordinate rides, and connect them to social services for food, housing, and job assistance.”
 

Is there a case in which you made the most difference?

Romero shares one of his favorite cases. “I was working with a woman in her late seventies, who I had been supporting for a few years. She had been experiencing bipolar disorder for a long time and was now struggling with early dementia.

“She had been doing well, but recently stopped taking her medication due to issues related to the dementia. I had collaborated with her provider to get her on medication monitoring, but she was now pushing back. Due to her cognitive issues, she also stopped seeing her primary care provider.

“I met with the woman and her son at her apartment. We discussed how she needed to accept more help. I was able to get the woman and her son to agree, and get her back on medication and regular care. We had a positive outcome, which was amazing, because it doesn’t always work out that way.”
 

How did you get your role?

“I began my career in the television industry and discovered that I didn’t like it, due to the extreme stress. I went into therapy, got into yoga, and went back to school to study counseling. I loved the program and thrived. I was thrilled that I could study this material, and work in the field of helping people. I got my degree, worked as a counselor for years, and then found the role at Carelon.”
 

What inspires you the most about your job?

“I love seeing people make positive changes in their lives. I care about people. It’s so rewarding to see people you work with make impactful changes, doing the best they can, and showing resilience. I admire individuals who have been through a lot of bad things still striving to make positive change in their lives. I enjoy helping people. It comes naturally to me.”