Care Manager: Integrated Health & Care Coordination

AltaPointe Health; Mobile (AL); On-site; USD 45,000 - 65,000; Full time

Job summary

AltaPointe Health in Mobile, AL seeks a Care Manager to coordinate behavioral health services, manage referrals, and support treatment plans across hospital and community partners. You will document in the EHR, track progress with PHQ-9 and other tools, and ensure timely follow-ups while maintaining patient-centered, collaborative care within an interdisciplinary team.

The role emphasizes strong organizational skills, independent work, and active participation in performance improvement

Qualifications

• Strong knowledge of behavioral health systems, including mental health, substance use, and social determinants of health.
• Proficiency in navigating and documenting within electronic health records (EHR), including coordination systems like Avatar or equivalent.
• Experience with treatment planning, interagency coordination, and client engagement.
• Strong organizational and communication skills, including ability to document accurately and follow up on tasks.
• Ability to work independently and as part of an interdisciplinary team.

Responsibilities

• Chart Review and Documentation: Review clinical records, assess service utilization, document findings in the Care Manager System.
• Care Coordination: Coordinate physical, behavioral, and social health services across internal programs and external providers.
• Hospital Discharge and Transition Support: Conduct follow-up calls within 24 hours of hospital discharges and ensure follow-up appointments are scheduled.
• Service Monitoring and Engagement: Track client attendance, address disengagement, and review screening tools to inform care needs.
• Referral and Linkage Management: Create, follow up, and close referrals; resolve barriers to care.
• Risk Identification and Response: Monitor risk levels and support crisis planning.
• Treatment Plan Support: Align services with goals and update plans as needed.
• Ongoing Caseload Management: Manage caseloads and participate in team meetings.

Skills

Behavioral health knowledge

EHR navigation

Treatment planning

Interagency coordination

Documentation skills

Team collaboration

Education

Bachelor's degree preferred

High School diploma + 4 years experience

Tools

Avatar EHR

Job description

AltaPointe Health in Mobile, AL seeks a Care Manager to coordinate behavioral health services, manage referrals, and support treatment plans across hospital and community partners. You will document in the EHR, track progress with PHQ-9 and other tools, and ensure timely follow-ups while maintaining patient-centered, collaborative care within an interdisciplinary team.

The role emphasizes strong organizational skills, independent work, and active participation in performance improvement