The Reentry Care Manager (RCM) provides Reentry Targeted Case Management (rTCM) services to justiceinvolved members before and after release from incarceration. This role focuses on wholeperson, membercentered care, ensuring continuity of medical, behavioral health, substance use disorder (SUD), and healthrelated social needs (HRSN) services to support a safe and successful transition back into the community
The primary goal is to ensure integrated, person-centered care that improves health outcomes, reduces recidivism, and ensures seamless continuity of services. Direct experience with the population highly preferred.Our team focuses on safe reentry transitions, continuity of care postrelease, and consistent delivery of rTCM requirements. The Reentry Care Manager is central to driving those outcomes by completing assessments, developing memberdriven care plans, and ensuring followthrough across facilities, internal teams, and community providers. This role turns policy into action and directly supports better stability and health outcomes after release.
May have to go on video call with inmates/members. MUST HAVE A PROFESSIONAL/QUIET ENVIRONMENT TO WORK.Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs
May perform telephonic/digital outreach to assess member needs and collaborate with resources
Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders
Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members
Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs
Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services
Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs
Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
Performs other duties as assigned.
Complies with all policies and standards.
Connecting members who have troubles navigating the healthcare system. Working with homeless, addiction.
This role supports members during one of the highestrisk transition periods (reentry into the community) where strong coordination can directly influence stability, engagement in care, and longterm outcomes. This sense of purpose stays strong over time because the work consistently matters.
Education/Certification Required: Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2 4 years of related experience. Preferred: Licensure Required: Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required Preferred: Licensed BH will be my 1 st pick but if not, RN will suffice. Reason: We are lacking BH staff for our program. Years of experience required: 2-4 years of related experience working directly with patients/members. Experience in providing resources for food, housing, transportation.