Assures that members with complex medical and/or psychosocial needs have access to health care.
Assists in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of outcomes necessary to facilitate member access to healthcare services.
Advocates for the most appropriate care plan using sound clinical judgment and collaboration with internal and/or external contacts.
Communicate effectively while performing customer telephonic interviewing and communication with external contacts.
Educate members to enhance member understanding of illness/disease impact.
Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other healthcare providers.

Minimum Bachelor’s degree in nursing or RN certification in lieu of bachelor's degree or Master’s degree in Social Work, Counseling, Education, or related field and 3 years' experience in Acute or Managed Care/ experience with Medicaid or Medicare populations.
OR Bachelor’s degree in Social Work with five years’ experience in Acute or Managed Care/ experience with Medicaid or Medicare populations.
Preferred Experience working with high-risk pregnant women OR experience working with chronic condition adult populations OR experience with pediatrics.
3 years of experience in working in Acute Care/Managed Care/Medicaid and Medicare populations.
Bilingual English/Spanish language skills.
Case Management Certification.

Medical Case Manager – Behavioral Health

Key skills