Integrated Care Manager (44428)

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 65,000 - 90,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island is seeking an Integrated Care Manager to work with the integrated care team to coordinate care for high-risk member populations, ensuring quality and cost-effective, member-centered care.

The role emphasizes comprehensive assessments, care planning, and collaboration with families, PCPs, behavioral health professionals, and community partners to close gaps in care.

Qualifications

• Active, current, unrestricted RN, LMHC, LCDP, LCSW or LICSW license in RI.
• Minimum of two years care management, behavioral health, or community health experience.
• PC based software programs - intermediate level of proficiency.

Responsibilities

• Practice care management within licensure scope and coordinate care for high-risk members.
• Perform comprehensive assessments, develop interventions and goals with the care team.
• Communicate with providers, implement care plans and monitor outcomes.
• Document activities in Care Management software and coordinate referrals.
• Provide clinical oversight to outreach staff and participate in team collaborations.

Skills

Care management

Interpersonal skills

Organizational skills

Customer service

Software proficiency

Education

RN license (RI)

Bachelor's degree

Tools

Care Management 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

• 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.