Clinical – Care Manager – J01006 Care Manager – J01006 Position Available In [Unknown county], South Carolina

Clinical

• Care Manager
• J01006 Care Manager
• J01006#25-62138
  Various, SC
  All On-site 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:

Please reference area map attached for sourcing. Blue and Yellow areas (Side note: Columbus/Charleston is good area as it is 2-3 from everything). Attached also is team’sLJ schedule w/ deadlines for start dates

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
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. 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 new line of business from the state managing Medicaid Seriously Mentally Ill (SMI) members from ages 6-64 years of age. Members require at least 1 phone call monthly, 1 visit every 90 days and an annual assessment. Case managers are allowed a of caseload of no more than 60 members due to the intensive nature of the members. Purpose of plan to assure members are receiving all medications, attending all MD/ mental health clinic appts, have adequate housing and transportation to attend all appts.
This project has a go live date of 7/1/25. Since there is a cap on the amount of cases a CM can have we anticipate ongoing hiring needs.
Typical Day in the Role Daily schedule & OT expectations
Typical task breakdown and rhythm
Interaction level with team
Work environment description Schedule of 8 hours daily. CM will make calls, visits and coordinate care for members. Our work is driven by metrics from the state that all are time driven. We currently have 15 CMs. They will be issued a company owned computer and cellphone. The team interacts with one another thru Teams, calls or texts. All team members have “buddies” that also work in the same area and are available for co-visits.
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 It is a new line of business from the state. Growth for the company will bring added positions for upward movement. Ability to help at risk youth. Work with parents and children to achieve best outcomes. Will visit mental health facilities if members are located there and residential homes throughout the state.
Candidate Requirements
Education/Certification

Required:

Bachelor’s Degree

Preferred:

Bachelors does not have to be in nursing
Licensure

Required:

RN

Preferred:

RN required or LMSW Years of experience required
Disqualifiers
Best vs. average
Performance indicators Must haves: Bachelors degree in health related field LMSW Nice to haves: A background in Behavioral Health (BH) is helpful.

Disqualifiers:

Doesn’t want to travel Performance indicators: Able to meet strict deadlines related to documentation/visits/calls
Documented within 24 hours unless on Friday
HMs get report to note who’s out of compliance
Must be able to adapt to change Best vs.

average:

Top 3 must-have hard skills
Level of experience with each
Stack-ranked by importance
Candidate Review & Selection 1 Ability to handle frequent change in policies and procedures
2 Work independently to meet metrics
3 Team collaboration
Candidate Review & Selection Shortlisting process
Second touchpoint for feedback
Interview Information

Onboard Process and Expectations Projected HM Candidate Review Date:

There are deadlines for enrolling new employees in courses. Can discuss at meeting

Number and Type of Interviews:

1 Teams or Zoom interview
Extra Interview Prep for

Candidate:

None
Required Testing or Assessment (by Vendor): None
Manager Communication Preferences & Steps Background Check Requirements (List DFPS or other specialty checks here) Motor Vehicle Record from the DMV Do you have any upcoming PTO? 6/20 and 7/5 Colleagues to cc/delegate Christine Joyner Christine.

M.Joyner@CENTENE.COM