Care Manager

Responsibilities:

• Evaluate the needs of members via phone or in-home visits to recommend and facilitate care plans, including behavioral health and social determinant needs.
• Perform telephonic, digital, home, and/or other site visits to assess member needs and collaborate with resources.
• Develop ongoing care plans for members with high acuity and identify needed providers, specialists, and community resources.
• Coordinate between members, family/caregivers, community resources, and the care provider team to ensure accessible services.
• Monitor care plans/service plans and member status for changes in treatment side effects, complications, and clinical symptoms, providing recommendations based on identified needs.
• Facilitate care coordination and collaborate with appropriate providers or specialists for timely access to needed care or services.
• Collect, document, and maintain member information and care management activities to ensure compliance with state, federal, and third-party payer regulations.
• Provide education to members and families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, including behavioral health and social determinant needs.
• Provide feedback to leadership on opportunities to improve care and quality delivery for members in a cost-effective manner.
• Comply with all policies and standards.

Requirements:

• Master's degree in Behavioral Health or Social Work, or a degree from an Accredited School of Nursing.
• 2 – 4 years of related experience.
• Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN with BH experience required.
• For Illinois Youth Care plan: Graduate degree and independently licensed behavioral health clinician (e.g., LCSW, LCPC, PsyD) in Illinois or Bachelor's Degree and IL RN licensure. Must reside in IL.
• For NJ Health Plan: Master's degree in Behavioral Health or Social Work and a Licensed Associate Counselor (LAC) or Licensed Social Worker (LSW) required.
• For Sunshine Health (FL): Master's degree in social work or related field and one year of related professional pediatric care experience. May require up to 80% local travel.