Care Manager

Evaluate the needs of the member via phone or in-home visits related to the resources available, and recommend and/or facilitate the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs. Perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources. Develop ongoing care plans for members with high-level acuity and work to identify providers, specialists, and community resources needed for care including mental health and substance use disorders. Coordinate as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members. Monitor care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications, and clinical symptoms and provide recommendations to care plan/service plan based on identified member needs. Facilitate care coordination and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services. Collect, document, and maintain member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations. Provide 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. Provide feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner. Perform other duties as assigned. Comply with all policies and standards. Summary Location: Sunflower Health Plan Field Worker: Yes Responsibilities Evaluate the needs of the member via phone or in-home visits related to the resources available, and recommend and/or facilitate the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs. Perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources. Develop ongoing care plans for members with high-level acuity and work to identify providers, specialists, and community resources needed for care including mental health and substance use disorders. Coordinate as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members. Monitor care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications, and clinical symptoms and provide recommendations to care plan/service plan based on identified member needs. Facilitate care coordination and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services. Collect, document, and maintain member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations. Provide 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. Provide feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner. Perform other duties as assigned. 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. Minimum 2 years of related experience. 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. #J-18808-Ljbffr Axelon Services Corporation