Senior Care Manager
Core
Develops, assesses, plans, implements, and coordinates complex care management activities for members with high-level acuity, primarily focused on behavioral health and social needs.
Role type
Senior Care Manager (Clinical)
Builds
Personalized care plans and service plans for members with complex behavioral health and social determinant needs
Domain
Healthcare / Behavioral Health / Managed Care
Required skills
Case management, care coordination, behavioral health expertise, social needs assessment, care plan development, provider collaboration, regulatory compliance, data review for care gaps, member education, precepting/coaching
Preferred skills
Familiarity with HMO and Medicaid plans, knowledge of SSI and TANF programs, experience with mental health and substance use disorders
Technologies
Telephonic outreach, digital tools, home visit platforms
Responsibilities
Develops and continuously assesses ongoing care plans for members with high-level acuity via phone or in-home visits; Coordinates between members, families, and care provider teams to ensure accessible services; Monitors member status and outcomes, revising care plans based on identified needs; Identifies barriers to care and implements appropriate interventions for complex cases; Reviews member data to identify health risks and care gaps; Collaborates with healthcare providers to facilitate timely access to needed care; Provides education to members and families on procedures, treatment options, and benefits; Precepts and coaches clinical new hires on navigating the Managed Care Organization environment.
Seniority
Senior, hands-on IC with mentorship responsibilities