Integrated Care Manager

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 70,000 - 90,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island seeks an Integrated Care Manager to work with the care team to coordinate care for high-risk members and ensure quality, cost-effective, patient-centered outcomes.

The role emphasizes comprehensive assessments, care planning with PCPs and behavioral health professionals, and ongoing monitoring. Strong licensing in RI, care management experience, and solid communication skills are required.

Qualifications

• Active, current, unrestricted RI licensure in a relevant field (RN, LMHC, LCDP, LCSW or LICSW).
• Minimum of two years care management, behavioral health, or community health experience.
• Strong organizational and interpersonal skills; customer service orientation.

Responsibilities

• Practice care management within licensure scope and coordinate care for high-risk member populations.
• Perform comprehensive assessments and develop care plans with stakeholders including PCPs and behavioral health professionals.
• Coordinate services, facilitate referrals, and monitor outcomes with regular plan-of-care updates.
• Document all activities accurately in Care Management software and ensure timely communications with the care team.
• Provide clinical oversight to outreach staff and participate in outreach/marketing activities as needed.

Skills

Care management

Behavioral health

Organizational skills

Interpersonal skills

Customer service orientation

Independent work

Education

RI license required (RN/LMHC/LCDP/LCSW/LICSW)

Bachelor's or Master's degree preferred

Tools

PC-based software

Job description

The Integrated Care Manager (ICM) works collaboratively with the integrated care team to manage and coordinate care for a specific population of members whose needs represent high clinical and social risk in order to ensure quality and cost-effective member-centered care.

Duties And Responsibilities

Responsibilities include, but are not limited to the following:

• Practice care management within the scope of licensure.
• Utilizes care management principles and sound clinical judgment in coordinating care for a specific member population
• Performs intensive care management functions for identified individuals in order to promote quality, cost-effective outcomes, including but not limited to:
• Performing a comprehensive assessment which includes care planning activities including the development of interventions, short and long-term goals in collaboration with member, family, PCP, behavioral health professionals and other involved health care professionals and community agencies, as appropriate
• Communicate with providers to facilitate needed care
• Implements care plan, facilitates referrals, coordinates services, and resources and provides ongoing monitoring and re-evaluation of outcomes
• Continuous monitoring and evaluation of the care outcomes and identification of service gaps
• Regular review and revision of the plan of care in collaboration with the family and appropriate members of the health care team based on the outcomes and evaluative findings
• Off-site visits (such as but not limited to home, hospital or community health centers or other community agencies) as necessary or required
  • Completes comprehensive documentation of all activities and contacts in Care Management software system
  • Facilitates referrals and coordinates needed services
  • Collaborates with team as necessary in identifying needed services and supports
  • Communicates with ancillary departments, such as Provider Relations and Member Services, as necessary to meet individual needs of members and providers
  • Meets department and regulatory standards for accuracy, proficiency, and documentation in order to communicate decisions and plan of care in an appropriate and timely manner
  • Provides clinical oversight to community outreach and other team members, providing direct supervision of community outreach staff as appropriate regarding individual care status
  • Serves as a clinical resource to respond to questions from various departments
  • Provides cross-coverage as assigned
  • Participates in outreach/marketing activities as needed and as appropriate
  • Other duties as assigned

Qualifications

Required

• Active, current, unrestricted RN, LMHC, LCDP, LCSW or LICSW license in RI in good standing (Consideration will be given to individuals without current RI license. Must provide documentation confirming application within 24 hours of offer)
• Minimum of two (2) years care management, behavioral health, or community health experience
• PC based software programs – intermediate level of proficiency
• Strong organizational and interpersonal skills
• Customer service orientation
• Ability to work independently and prioritize activities
• Must have access to reliable transportation. If using personal vehicle, must have active driver’s license and auto insurance

Preferred

• Managed Care experience
• Certified Care Manager
• Demonstrated experience working with Medicare, Medicaid, and commercial products
• Bachelors degree
• Masters degree
• Bilingual
• Behavioral Health and/or Substance use expertise

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.