Job Profile Summary: 
 
Position Purpose: 
Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder. 
 
Education/Experience: 
Requires a 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. 
 
 
License/Certification: 
Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required 
 
For Illinois Youth Care plan only: 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 required 
 
For NJ Health Plan Only: Requires a 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) Only: Employees supporting Florida's Children’s Medical Services must Hold a Master’s degree in social work or related field and have one year of related professional pediatric care experience. May require up to 80% local travel required 
 
Responsibilities: 
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, home and/or other site visits 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.

Right to Hire - Behavioral Health Case Manager

$40 - $23/hr

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