Clinical - Care Manager - J01006 Care Manager - J01006

Mindlance; Clayton (MO); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare company is looking for a Behavioral Health Care Manager to manage complex care for mental health needs. The role requires a Master's degree in Behavioral Health and involves extensive telephonic interactions with members, facilitating care plans, and compliance monitoring. This fully remote position offers opportunities for growth and development within the company.

Qualifications

• Requires a Master's degree and licensed in the relevant state.
• 2-4 years of relevant behavioral health experience.
• Must have behavioral health or medical experience.

Responsibilities

• Develops and facilitates care management activities focusing on mental health.
• Evaluates member needs via telephonic outreach and home visits.
• Monitors and adjusts care plans based on treatment outcomes.

Skills

Care coordination

Resource management

Advocacy

Telephonic outreach

Education

Master's degree in Behavioral Health or Social Work

Tools

Microsoft Teams

Clinical documentation systems

Job description

Job Description: 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.
Comments for Vendors:

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”

======== Centene Job Description
Story Behind the Need – Business Group & Key Projects

• Health plan or business unit
• Team culture
• Surrounding team & key projects
• Purpose of this team
• Reason for the request
• Motivators for this need
• Any additional upcoming hiring needs?

This is a need to replace a behavioral health care manager who will be going on maternity leave in May 2025 and will support the adoption subsidy/DYS team within the Home State Health Show Me Healthy Kids specialty plan with behavioral health care management cases. The typical cases that they manage are children/adolescents who require extra support included but are not limited to: frequent inpatient psychiatric hospitalizations, autism/developmental delay diagnoses, aggression/oppositional defiant disorder, and need for residential behavioral health treatment. Typical Day in the Role

• Daily schedule & OT expectations
• Typical task breakdown and rhythm
• Interaction level with team
• Work environment description

Daily schedule: Monday-Friday 8:00 am-5:00 pm CST, 1 hour lunch break. No overtime, weekends or holidays.
Typical task breakdown and rhythm: 60-80 BH CM cases with 20% of cases being complex. Less than 20 care coordination cases with fewer needs. Productivity expectation of 14 calls per day, audit expectation of 95% and above. Must be able to prioritize tasks for compliance.
Interaction level with team: Fully integrated and involved in the team, team meetings and expectations.
Work environment: Fully remote work-from-home. Must have private office space due to HIPAA laws and privacy needs. Interaction with team takes place regularly virtually through Microsoft Teams messages and calls. Compelling Story & Candidate Value Proposition

• What makes this role interesting?
• Points about team culture
• Competitive market comparison
• Unique selling points
• Value added or experience gained

This is a fully remote work-from-home position that does not include field visits to see members in the community. Interaction with members is telephonic only. There is room for growth within the company of Centene since we have so many markets and departments if competence is displayed at this role and the employee converts to full time work. Candidate Requirements Education/Certification Required: Master’s degree in behavioral health or social work Preferred: MSW Licensure Required: LCSW, LMSW, LPC Preferred: LCSW

• Years of experience required
• Disqualifiers
• Best vs. average
• Performance indicators

Must haves: 2-4 years

Nice to haves: 5+ years

Disqualifiers: No license or behavioral health/medical experience.

Performance indicators: 14 calls to members per day, 95%+ score on clinical quality audits.

Best vs. average: Case management experience & social worker BEST

• Top 3 must-have hard skills
• Level of experience with each
• Stack-ranked by importance
• Candidate Review & Selection

1 Case management experience 2 Experienced with using multiple technologies/platforms including Microsoft Teams, clinical documentation systems. 3 Resource management and advocacy Candidate Review & Selection

• Shortlisting process
• Second touchpoint for feedback
• Interview Information
• Onboard Process and Expectations

Projected HM Candidate Review Date: 2/19 Number and Type of Interviews: Virtual interviews on Microsoft Teams CAMERA ON Extra Interview Prep for Candidate: Required Testing or Assessment (by Vendor): Manager Communication Preferences & Next Steps

• Background Check Requirements (List DFPS or other specialty checks here)

Background check required, no specialty checks.

• Do you have any upcoming PTO?

• Colleagues to cc/delegate

TBD