Care Manager

Summary:

• Location: Sunflower Health Plan
• Field Worker: Yes

Responsibilities:

• Evaluate the needs of the member via phone or in-home visits related to the resources available, and recommend and/or facilitate the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs.
• Perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources.
• Develop ongoing care plans for members with high-level acuity and work to identify providers, specialists, and community resources needed for care including mental health and substance use disorders.
• Coordinate as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members.
• Monitor care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications, and clinical symptoms and provide recommendations to care plan/service plan based on identified member needs.
• Facilitate care coordination and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services.
• Collect, document, and maintain member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations.
• Provide 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.
• Provide feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements:

• Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing.
• Minimum 2 years of related experience.
• 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.