Care Manager II

Role Overview: The Care Manager II partners with members, caregivers, providers, and community resources to assess needs, develop individualized care plans, address barriers to care, and promote self-management with complex medical, behavioral health, and social needs by providing comprehensive care coordination and case management to help members achieve their optimal level of health and improve overall health outcomes.

Work Arrangement:

• Fully remote position; candidates must reside in Ohio.
• Some travel may be required within a 60-mile radius to engage with members at provider offices and community locations.
• Reliable high-speed internet is required to support daily job responsibilities, with a minimum bandwidth of 50 Mbps download and 5 Mbps upload.
• Associates residing in states where reimbursement is required by law, regulation, or contract may be eligible for internet reimbursement.

Responsibilities:

• Assess members to determine eligibility and need for care coordination and case management services.
• Complete comprehensive, person-centered assessments that evaluate physical health, behavioral health, psychosocial needs, environmental factors, and social determinants of health.
• Identify clinical, behavioral, and social barriers impacting member health and developing appropriate intervention strategies.
• Develop, implement, and monitor individualized care plans to improve health outcomes and promote self-management.
• Establish short- and long-term goals with members and caregivers, including measurable timelines and action plans.
• Coordinate physical, behavioral, and social services, as well as community-based resources, to meet member needs.
• Provide medication management support, including medication reconciliation, adherence monitoring, and member education.
• Implement appropriate care management interventions based on member acuity, needs, and clinical progress.
• Conduct follow-up outreach, care plan reviews, and ongoing assessments to monitor progress and address emerging needs.
• Make referrals to internal and external resources as appropriate and facilitate access to services.
• Document all member interactions, care coordination activities, interventions, and outcomes in accordance with organizational and regulatory requirements.
• Collaborate with providers, caregivers, and interdisciplinary teams to ensure continuity of care and successful care transitions.
• Support members experiencing complex conditions, including behavioral health disorders, chronic conditions, maternal health needs, oncology diagnoses, and transition-of-care needs.

Education & Experience:

• Associate degree in nursing required.
• Bachelor of Science in Nursing preferred.
• Master's degree in Social Work required.
• 3 years of professional clinical experience working with adult and/or pediatric populations in one or more of the following areas: Behavioral Health, Physical Health, Oncology, Care Transitions/Discharge Planning, Community Health, Ambulatory Care, or Acute Care
• Previous case management or care coordination experience preferred.
• Experience within a managed care organization is highly preferred.
• Demonstrated experience assessing member needs, developing care plans, coordinating services, and promoting self-management.
• Ability to work independently while managing multiple priorities in a fast-paced environment.

Licensure:

• Current, active, and unrestricted Ohio Registered Nurse (RN) license.
• Current, active, and unrestricted Ohio license in good standing as one of the following:
• Licensed Social Worker (LSW), Licensed Master Social Worker (LMSW), Licensed Independent Social Worker (LISW), or Licensed Professional Counselor (LPC)
• Valid driver's license and car insurance.

Skills & Abilities:

• Strong knowledge of care management, care coordination, case management, and population health principles.
• Ability to perform comprehensive member assessments and develop effective care plans.
• Knowledge of social determinants of health and community-based resources.
• Strong clinical judgment and critical thinking skills.
• Ability to prioritize, organize, and manage multiple cases simultaneously.
• Excellent time management and follow-through skills.
• Strong communication and relationship-building skills with members, caregivers, providers, and community partners.
• Ability to work independently while collaborating effectively within a multidisciplinary team.
• Strong documentation and navigation skills for care management systems.
• Proficiency with electronic medical records (EMR), care management platforms, and Microsoft Office applications.
• Flexible, adaptable, and comfortable working in a dynamic and evolving healthcare environment.