Patient Care Manager remote jobs - 255 jobs

The Bilingual Lead Care Manager partners with Care Team Operations, Clinical Operations, Compliance, Community Health Workers, Behavioral Health staff, and external providers (medical, housing, and social services) to ensure seamless, culturally responsive, member-centered care coordination. The bilingual LCM additionally supports members with limited English proficiency by facilitating communication, translation, and cultural interpretation as needed. Responsibilities Serve as the primary point of contact for assigned members, building trust and maintaining active engagement through consistent outreach, relationship-based strategies, and a trauma-informed approach. Provide all communication in the member's preferred language. Conduct comprehensive assessments (physical, behavioral, functional, social) and develop person-centered care plans that reflect the member's goals, risks, preferences, cultural needs, and social determinants of health. Implement, monitor, and update care plans following transitions of care, significant changes in condition, or required reassessments; ensure timely and compliant submission of all care plans. Coordinate services across the continuum-including medical, behavioral health, housing, transportation, social services, and community programs-to reduce fragmentation and remove barriers to care. Conduct required in-person home or community visits based on member need and risk stratification and maintain a compliant monthly visit structure. Utilize motivational interviewing, coaching, and health education to promote behavioral change, self-management, and long-term member stability. Identify gaps in care, service delays, lapses in benefits, unmet needs, and environmental risks; collaborate with internal and external partners to resolve issues quickly and effectively. Maintain accurate, timely, audit-ready documentation of all interactions, assessments, and interventions using required HHN platforms, including eClinicalWorks (ECW), Google Suite, RingCentral, PowerBI dashboards, and payer portals. Meet or exceed HHN and payer productivity standards, including encounter metrics, outreach requirements, documentation timelines, and quality measures. Actively participate in multidisciplinary case reviews, team huddles, care conferences, and escalations with nurses, behavioral health staff, CHWs, care operations, and compliance. Coordinate and schedule appointments with primary care, specialists, behavioral health providers, and community partners; manage referrals, transportation, and follow-ups to ensure continuity of care. Support hospital discharge (TOC) planning through follow-up scheduling, care transitions, medication reconciliation support, and education on discharge instructions. Assist members in navigating plan eligibility, redeterminations, documentation, social service applications, housing resources, and crisis interventions. Maintain active and professional communication with members and care partners through HHN-approved channels, including RingCentral, secure messaging, SMS workflows, and phone. Participate in HHN's continuous quality improvement efforts, identifying workflow gaps, documenting barriers, sharing insights, and contributing to best-practice development. Uphold confidentiality and adhere to all HIPAA and payer regulatory requirements across all areas of care delivery. Open to seeing patients in their home or their location of preference. Provide real-time interpretation and translation support (verbal and written) for members and families with limited English proficiency. Help bridge cultural gaps that may impact communication, trust, adherence, or engagement. Skills Required Fluency in English and another language (Spanish preferred); ability to read, write, and speak at a professional level. Strong ability to build rapport and trust with diverse, high-need member populations. Proficiency in using eClinicalWorks (ECW), Google Suite (Docs, Sheets, Drive), RingCentral, and virtual communication tools. Ability to interpret and use PowerBI dashboards, reporting tools, and payer portals. Demonstrated skill in conducting holistic assessments and developing person-centered care plans. Experience with motivational interviewing, trauma-informed care, or health coaching. Strong organizational and time-management skills, with the ability to manage a complex caseload. Excellent written and verbal communication skills across in-person, telephonic, and digital channels. Ability to work independently, make sound decisions, and escalate appropriately. Knowledge of Medi-Cal, SDOH, community resources, and social service navigation. High attention to detail and commitment to accurate, audit-ready documentation. Ability to remain calm, patient, and professional while supporting members facing instability or crisis. Comfortable with field-based work, home visits, and interacting in diverse community environments. Cultural humility and demonstrated ability to work effectively across populations with varied lived experiences. Competencies Member Advocacy: Champions member needs with urgency and integrity. Operational Effectiveness: Executes workflows consistently and flags process gaps. Interpersonal Effectiveness: Builds rapport with diverse populations. Collaboration: Works effectively within an interdisciplinary care model. Decision Making: Uses judgment to escalate or intervene appropriately. Problem Solving: Identifies issues and creates practical, timely solutions. Adaptability: Thrives in a fast-growing, startup-style environment with evolving processes. Cultural Competence: Engages members with respect for their lived experiences. Documentation Excellence: Produces accurate, timely, audit-ready notes every time. Strong empathy, cultural competence, and commitment to providing individualized care. Ability to work effectively within a multidisciplinary team environment. Exceptional interpersonal and communication skills, with a focus on building trust and rapport with diverse populations. Bilingual Communication (interpretation + translation) Job Requirements Education: Bachelor's degree in Social Work, Psychology, Public Health, Human Services, or related field preferred; equivalent experience considered. Licensure: Not required; certification in care coordination or CHW training is a plus. Experience: 1-3 years of care management or case management experience, preferably with high-need Medi-Cal populations. Experience in community-based work, homelessness services, behavioral health, or SUD settings strongly preferred. Familiarity with Medi-Cal, ECM, and community resource navigation. Travel Requirements: Regular travel for in-person home or community visits (up to 45%). Physical Requirements: Ability to perform home visits, climb stairs, sit/stand for prolonged periods, and lift up to 20 lbs if needed.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The Global insurance Clinical Care Manager - Bilingual Japanese RN will perform prospective, concurrent, and retrospective reviews and non-urgent travel requests for Global Expat members located outside the United States. This is a 24/7 operation, and while your primary schedule will follow the hours listed above, occasional flexibility may be required to support members in Japan. You may need to adjust your schedule to accommodate their time zone, which could include early mornings, late nights, or weekends as business needs arise. These instances are rare and typically involve completing member outreach and any associated case review and documentation. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. This position supports the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs. Primary Responsibilities: A GI CCM must consider both US and international care standards and regulatory guidelines. They must be able to work in multiple platforms and comfortable communicating with members and providers to obtain information needed to perform the clinical review Must also be willing to be cross trained to assist Clinical Health Managers in pre-admission and post-discharge member outreaches The clinical team is also involved in fraud investigations, identifying multiple fraudulent clients and claims You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Registered Nurse with an active unrestricted United States license Must be bilingual in Japanese and English, with strong verbal and written communication skills 3+ years of experience in medical-surgical inpatient acute care Experience with working in collaboration with Medical Director to review care plans make recommendations. Ability to advocate on behalf of the member's needs while considering contractual limitations Proven experience in Clinical Coverage Review, Medical Claim Review or Clinical Appeals Proven communication skills at all levels Proven ability to be flexible and display a positive attitude Proven solid problem-solving, organizational and crisis management skills Proven ability to function confidently and efficiently in fast paced work environment Proven ability to foster team cohesion in an international virtual environment Proven ability to provide empathetic and courteous service while working effectively with co-workers face-to-face or remotely in dynamic and emergent situations Demonstrated cultural competence and awareness of the challenges of healthcare delivery in the global arena and the potential impact on the health and safety of expatriates, business travelers and UHC Global members Proven advanced software skills with ability to work in multiple platforms with clinical case reviews Proven advanced skills with Microsoft Office - Excel, Word Ability to work in the Eastern time zone (EST) which is 3:00pm-11:00 pm. If you reside in Central time zone (CST) hours would be 2:00pm-10:00pm for Mountain time zone (MST) hours would be 1:00pm-9:00pm, for Pacific time zone (PST) hours are 12:00pm-8:00pm. Monday- Friday with potential to work limited overnight and/or weekend hours based on client or member needs Preferred Qualifications: Bachelor's degree 2+ years of experience in utilization management or case management in a managed care or hospital environment Experience in international healthcare and/or air medical transport Experience in discharge planning and/or chart review International travel experience Demonstrated familiarity with InterQual criteria guidelines *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Omatochi is actively seeking a compassionate and detail-oriented Care Manager to join our team. In this non-medical role, you will play a crucial part in coordinating and overseeing support services for our clients. The Care Manager will work closely with various stakeholders to ensure our clients receive the assistance and resources needed to improve their quality of life. The ideal candidate for this position is empathetic, organized, and possesses excellent communication skills. Responsibilities: Client Assessment and Support Planning: Conduct thorough assessments of clients' needs, considering their personal, social, and emotional requirements. Develop tailored support plans in collaboration with clients, their families, and relevant agencies. Coordinate with community resources to provide clients with appropriate services and assistance. Care Coordination and Advocacy: Serve as the main point of contact for clients, connecting them with relevant services and programs. Advocate for clients' needs, ensuring they receive timely and adequate support from various organizations and service providers. Monitor the progress of support plans and adjust them as necessary to meet clients' changing requirements. Client and Family Education: Educate clients and their families about available support services, community resources, and self-help techniques. Provide guidance on effective coping strategies and assist in developing life skills. Address clients' concerns and queries, building a trusting and supportive relationship. Documentation and Reporting: Maintain accurate records of client assessments, support plans, and interactions. Generate detailed reports on client outcomes, program effectiveness, and areas for improvement. Ensure compliance with organizational protocols and reporting requirements. Collaboration and Professional Development: Collaborate closely with community organizations, social workers, and relevant agencies to enhance the overall quality of client support. Participate in regular team meetings, training sessions, and workshops to stay informed about the latest developments in social services and care management. Pursue continuous professional development, seeking opportunities to expand knowledge and skills in the field of care management. Qualifications: Valid Drivers License and Vehicle Bachelor's degree in Social Work, Psychology, Counseling, Human Services, or a related field. Proven experience in non-medical care management, case management, or social services. Strong understanding of social service regulations, policies, and procedures. Excellent interpersonal skills, including active listening and empathy. Ability to work independently, prioritize tasks, and manage time efficiently. Proficiency in using case management software and other relevant tools. Benefits: Competitive salary and performance-based incentives. Comprehensive benefits package, including health, dental, and vision insurance. Generous paid time off, including vacation, personal days, and holidays. Ongoing professional development opportunities. Region and Travel: This is a position with a strong field-based component. While the incumbent will have flexibility to work from home, they are expected to travel extensively-approximately 50% to 80% of the time-within Santa Cruz County. This role requires a high level of mobility and availability to attend in-person visits, community events, and other field-based responsibilities throughout the geographic area of responsibility. Mileage Reimbursement / Vehicle Allowance: Travel-related expenses are reimbursed and whether a monthly stipend is provided for vehicle use. Scheduling Flexibility: Incumbent has autonomy over scheduling and is responsible for balancing field and administrative work. Omatochi is committed to creating an inclusive and diverse work environment. We encourage applications from candidates of all backgrounds and experiences.

Job Title: Patient Access Manager - Remote Job Country: United States (US) Here at Avanos Medical, we passionately believe in three things: * Making a difference in our products, services and offers, never ceasing to fight for groundbreaking solutions in everything we do; * Making a difference in how we work and collaborate, constantly nurturing our nimble culture of innovation; * Having an impact on the healthcare challenges we all face, and the lives of people and communities around the world. At Avanos you will find an environment that strives to be independent and different, one that supports and inspires you to excel and to help change what medical devices can deliver, now and in the future. Avanos is a medical device company focused on delivering clinically superior breakthrough solutions that will help patients get back to the things that matter. We are committed to creating the next generation of innovative healthcare solutions which will address our most important healthcare needs, such as reducing the use of opioids while helping patients move from surgery to recovery. Headquartered in Alpharetta, Georgia, we develop, manufacture and market recognized brands in more than 90 countries. Avanos Medical is traded on the New York Stock Exchange under the ticker symbol AVNS. For more information, visit *************** Essential Duties and Responsibilities: The Patient Access Manager is part of the Market Access, Reimbursement, and Medical Policy (MA&R) team. The MA&R team supports internal and external customers navigate through reimbursement nuances and barriers, the facilitation of authorizations and appeals, and collaborates with key opinion leaders, Specialty Societies, Government organizations, and payer decision makers to influence coverage via policy change in efforts to increase access to Avanos products. This role will primarily focus on the Avanos Pain Management and Recovery product portfolios, radiofrequency ablation products. The Patient Access Manager is a subject matter expert who will be directly responsible for development, oversight, and management of the Avanos Patient Access Program and team, and strategic initiatives in efforts to optimize access to Avanos Medical's Pain Management and Recovery portfolio products. Key Responsibilities: * Develops, implements, and manages the Avanos Patient Access Program and team members; including but not limited to program operations and processes to ensure superior support is provided, processes are followed, and compliance is maintained. * Hires and manages direct reports, including but not limited to performance reviews, time-off requests; ensuring superior support is provided, processes are followed, compliance is maintained, and direct reports are able to function in a productive, accurate, and efficient manner. * Is an expert level resource to provide on-the-job training for new hires, ongoing training, guidance, mentoring, and support to direct reports to resolve complex patient access issues and advance knowledge, foster career growth and expand team capabilities. * Performs frequent internal reviews and audits to ensure program operations remain aligned with strategic initiatives and direct reports are performing effectively as defined in program process and procedures documents, monitors case assignments to assess productivity, hiring needs, and serves as a back-up to ensure adequate staffing is available for all operations under the Patient Access Program. * Provides expert level acumen and support on patient access program processes and initiatives to support internal and external customers. Serves as the primary source of contact for addressing issues more complex than others serving on the Patient Access team may be required to know in an accurate, consistent, timely and compliant manner. * Analyzes program outcomes and recognizes trends/issues that hinder patient access, crafts strategic and tactical recommendations, and implements initiatives to adapt the program operations based on changing payer processes and requirements and to improve program outcomes and efficiency; including but not limited to program resources and collateral, processes, and procedures, as well as training documents and plans. * Fosters a strong alliance with the MA&R Team in the identification applicable market access, reimbursement, and payer coverage changes and/or trends at the customer, regional, and national levels that may impact patient access to Avanos products. Partners in the development and pull-through of strategic initiatives in efforts to increase access and neutralize barriers to Avanos products. * Aids in the development, preparation, and presentation of educational materials regarding patient access and program outcomes (e.g., training, workshops, and presentations). * Establishes professional relationships and maintains an effective communication network with the internal and external customer at multiple levels. * Participates in the operations of the Avanos Patient Access Program as needed; including but not limited to data entry, preparing, and facilitating appeals, collecting necessary documentation to fulfill payer requirements, and processing payer determinations. * Demonstrates uncompromised ethics while helping others understand legal and regulatory parameters related to patient access and adheres to Corporate Compliance programs and successfully participates in training and continuing education programs. * Performs other duties and projects as required/needed. Your qualifications Required: * Bachelors degree * Minimum of 3 years' experience within patient access, medical benefits, health insurance standards and authorization processes, and reimbursement with a comprehensive understanding of obtaining patient access of procedures across government and private payer environments specific to surgical procedure(s), and/or medical device(s), and/or DME, and/or biologic(s). * Minimum of 2 years' experience with direct oversight and management of the operations of a patient access program and team with a successful record of managing direct reports. * Advanced, in-depth knowledge of medical benefits, insurance standards, pre- service insurance authorization processes and requirements for reimbursement from government and private payers and ability to locate and interpret payer pre-service review requirements, policies, coverage determination making processes, etc. * Experience with educational presentations to external and internal customers with exemplary ability to provide superior support to internal and external customers and to expertly navigate through challenging situations. * Collaborative work ethic, exemplary leadership skills, excellent project and time management and communication (written and verbal) skills. * Proficient in using Microsoft PowerPoint, Excel, Windows, and Microsoft Office. Experience with data visualization software (e.g., Tableau) and CRM applications (e.g., Salesforce.com) or aptitude to learn such tools. General ability to learn and acclimate to new systems. * Working knowledge of compliance and regulatory mandates in medical device/technology environments; including but not limited to HIPAA, HITECH, ADVAMED, and Federal Statutes. Travel: Less than 10% The statements above are intended to describe the general nature and level of work performed by employees assigned to this classification. Statements are not intended to be construed as an exhaustive list of all duties, responsibilities and skills required for this position. Salary Range: The anticipated average base pay range for this position is $130,000.00 - $150,000.00. In addition, this role is eligible for an attractive incentive compensation program and benefits. In specific locations, the pay range may vary from the base posted. #LI-Remote Avanos Medical is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity or any other characteristic protected by law. IMPORTANT: If you are a current employee of Avanos or a current Avanos Contractor, please

Insight Global is hiring for a Remote Care Manager to support our micro clinic operations in Raleigh, NC. You will work in a virtual setting with providers, paramedics, and patients to partner in the care continuum process. You will lead the clinical onboarding of new contracts, handle referrals & authorizations, and ensure seamless communication with all stakeholders. Responsibilities will include: · Develop and monitor care plans in collaboration with multiple providers, adjusting as needed · Follow up on interventions to prevent unnecessary ER visits and hospital admissions · Serve as the primary liaison between patients, families, and healthcare staff to ensure seamless communication · Navigate multiple healthcare platforms including EHRs, payer portals, billing software, and patient messaging systems · Ensure timely and accurate documentation across systems to support care continuity and compliance · Verify provider participation, coverage, and pre-authorization requirements with insurance administrators and healthcare facilities · Optimize client contracts and referral workflows to enhance scalability and efficiency in care coordination · Schedule and manage appointments, follow-ups, and referrals to specialists and services · Educate patients on conditions, medications, and treatment plans to promote understanding and adherence · Track patient progress and address barriers to treatment plan compliance We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to ********************.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: **************************************************** Skills and Requirements · RN Licensure or Paramedic Licensure in North Carolina · Minimum of 3 years of experience in care coordination (care or case management) · Strong knowledge of insurance benefits, prior authorizations, and referral management · Proficiency with EMR/EHR systems, payer portals, and standard office software (60% of role) · Strong communicational & organizational skills - ability to work efficiently with a team

Salvo is looking for an experienced Nurse to support our chronic disease patients. In this role, you'll be a key contributor to the management and delivery of our care program, working closely with our patients, registered dietitians, and partner physicians to provide best-in-class care. You'll use your medical knowledge and product expertise to help our members navigate Salvo Health, assisting in medical and administrative tasks to keep the member moving through the program. Additionally, you'll help shape how we build and scale our product and process. Our ideal candidate is someone who enjoys the challenges of an early-stage start up, is eager to learn, process oriented, and has a patient-first mindset. What You Will do: Provide exceptional care, disease management and health education to patients Support goal setting for individual patients asynchronously to help them better manage their chronic conditions Create personalized action plans with guidelines to reduce or eliminate unwanted behaviors Help clients understand their motivations and create behavior change plans Conduct regular outreach to patients, based on their needs and preferences, to support engagement and elicit behavior change Coordinate with other clinical team members to provide an exceptional patient experience Develop and maintain professional, support-oriented working relationships with patients and team members Create and distribute health education materials to individual members as necessary Work with a cross-functional product team to develop and constantly improve our in-app patient experience Qualifications: 2+ year of experience as Licensed Practical Nurse or any Nursing license 2+ years of experience in patient-facing or customer-facing roles Compact state license required, additional licensing may be needed Bilingual (spanish speaking) a plus Excellent customer relation skills, as well as written and verbal communication skills Knowledge of medical terminology and proficiency of general medical office procedures Familiarity with digital applications like Slack, Coda, Google Workspace, etc. Strong analytical and proactive problem solving skills Self-motivated, results-oriented and strategic thinker Personal passion for health and wellness topics Must be authorized to work in the United States Experience working in telehealth or healthcare startup environment preferred Bonus: Experience working in GI, weight management, and/or with anti-obesity medications such as GLP-1s Salvo is a new approach to help millions of Americans facing chronic health conditions, centered on chronic gut health and metabolic conditions from IBS to obesity. Our patients are assigned a “whole patient” care team and have seven day a week access to app-based care, using Remote Patient Monitoring (“RPM”) to bill under the patient's insurance. This is a major step forward to go beyond episodic appointments to continuous care at home, and deliver interdisciplinary wraparound care in partnership with the patient's existing local doctor. Salvo is backed by leading health care investors from innovators like Livongo, Ro, Ginger, Forward, Brightline, Tia, and others. Salvo care draws on expertise from Board-certified specialty physicians, registered dietitians, nurses, psychologists, and therapists who have developed our evidence-based protocols, for a personalized, multi-month journey to better health. Salvo is the first to bring a scalable and tech-enabled, more integrative approach to these chronic conditions, going beyond treating only the symptoms in order to identify and address the root causes of chronic illness. Salvo offers a competitive salary and health benefits, a remote work environment, flexible time-off, a larger sense of mission, and professional development and entrepreneurial opportunities. Working alongside a bunch of super talented and friendly people, in a culture that likes to drive constant innovation, and marked by relentless curiosity and a sense of empathy. Salvo is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. • Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. • Conducts telephonic, face-to-face or home visits as required. • Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. • Maintains ongoing member caseload for regular outreach and management. • Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. • Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. • Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. • Assesses for barriers to care, provides care coordination and assistance to member to address concerns. • May provide consultation, resources and recommendations to peers as needed. • Care manager RNs may be assigned complex member cases and medication regimens. • Care manager RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications • At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. • Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). • Demonstrated knowledge of community resources. • Ability to operate proactively and demonstrate detail-oriented work. • Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. • Ability to work independently, with minimal supervision and self-motivation. • Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. • Ability to develop and maintain professional relationships. • Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. • Excellent problem-solving, and critical-thinking skills. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications • Certified Case Manager (CCM). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Do you dream of a role where you can connect with people and transform lives - all while working remotely? We're looking for Care Managers who thrive on building relationships with families with adult neurodivergent children - understanding their goals and helping them access specialized resources. Join us and transform the lives of hundreds of adults with developmental disabilities as you scale with a high-growth, innovative company. At NeuroNav, we believe everyone deserves the opportunity to make their own choices and shape their story, regardless of disability. Our mission is to enhance the quality of life for adults with developmental disabilities through simplicity and choice. We specialize in helping families navigate a specific California state funded program called Self-Determination, which offers more creative and custom choice as to how to leverage state funds. This is a life-changing program and you will be the conductor, breaking down barriers for your client and ensuring his or her success. As one of our virtual Care Managers (the heart and soul of our team called “Navigators” internally), you'll create custom client plans and guide families in a step-by-step process to enter and maintain participation in this program. In this remote role, you will be able to leverage your creativity, kindness and relational skills in social work, case management, and service coordination to transform your clients' lives and help them write the stories they dream of. About NeuroNav Founded at Stanford in 2020, with support from the Stanford Innovation Fellowship, Pear VC and Core Innovation Capital, NeuroNav drives new vision and change in disability by creating personalized care plans and connecting our neurodivergent clients with virtual Care Navigators who help manage their benefits. Last year, we supported hundreds of individuals in accessing life-changing services, and we're on track to quadruple our impact next year. Responsibilities include: Person-centered Planning - you will be trained in a special facilitation framework to capture your client's unique strengths, goals, needs and desired outcomes and align them to a plan unique to them. Budget & Spending Management - you will help translate personalized plans into concrete support needs and advocate for those needs to local budget authorities. Project Management - you will be the driver that holds the process together and guides the client and other partner organizations. Service Provider Access - you will leverage NeuroNav's proprietary resources to search for and assist providers in implementing person-centered plans throughout the year. Special Projects - you will contribute your talent and insights from working with clients into key company strategy and initiatives each quarter. What You'll Bring Bachelor's Degree or equivalent work experience Social Work or case management experience in the disability or social services field Client-facing experience managing multiple relationships at one time Excellent written and verbal communication skills Must have computer, reliable high-speed internet connection, and a quiet work environment Fluent in Spanish and bilingual (strongly preferred) Experience in a performance-based culture with metrics attainment goals (preferred) Experience serving in the developmental disability field (preferred) Experience with Microsoft Office & Google Suite (preferred) Experience in person-centered planning and in the California developmental disability system (preferred) Experience in Case management: 2 years (Preferred) Benefits We believe in supporting our employees' well-being and work-life balance as part of our culture and offer the following benefits: Remote first - Ability to work from home Health, vision and dental insurance 401(k) 14 Paid Time Off (PTO) days per year 7 sick or flex days per year Annual company retreat Salary: $50-60k per year (depending on experience)

We are a rapidly growing healthcare organization dedicated to supporting patients living with chronic conditions. Our mission is to deliver personalized, high-quality care that empowers individuals to take control of their health with confidence. Through a fully remote model, our Care Managers guide patients through their care journeys-educating, advocating, and coordinating support that leads to better outcomes and smoother day-to-day management. We're looking for a motivated Care Manager who is eager to apply their medical knowledge in a hands-on, patient-facing role. This position is ideal for someone with a healthcare diploma, training, or any form of medical education or clinical exposure who wants to put that foundation to meaningful use. You'll act as the central point of contact for patients, helping them understand their conditions, navigate care plans, and stay on track with treatment while working alongside providers, social workers, and community partners. Key Responsibilities: Monitor and coordinate care plans by tracking progress, adjusting interventions, and maintaining consistent patient support. Provide clear, accessible education about chronic conditions, treatment options, and lifestyle strategies. Coordinate appointments, follow-ups, and referrals, ensuring smooth connection to appropriate providers. Maintain accurate patient records, including health information, insurance details, and supporting documentation. Respond promptly and empathetically to patient questions, concerns, and urgent needs. Partner with care teams to develop, assess, and refine patient-centered interventions. Collaborate with behavioral health, disease management, home health, social work, and community organizations for holistic care. Ideal Qualities and Skills: Strong verbal and written communication skills and the ability to simplify medical information for patients. Fluency in Spanish (spoken and written), with the ability to support Spanish-speaking patients and families. Solid problem-solving instincts and a proactive approach to anticipating patient needs. Organized, detail-oriented, and reliable in managing patient caseloads and documentation. Comfortable prioritizing tasks and managing time effectively in a remote environment. Collaborative mindset with genuine care for patient well-being. Healthcare diploma or equivalent preferred. Any level of medical or healthcare experience-clinical rotations, internships, coursework, or similar-is welcomed. Compensation: Competitive hourly rate of $15-$20 per hour, based on experience and qualifications (Full Time). A supportive remote environment with opportunities for professional growth and development. Fully Remote opportunity.

About the role The April Parker Foundation is seeking compassionate, detail-oriented Care Managers (Generalists) to deliver Enhanced Care Management (ECM) and Community Supports (CS) services to Medi-Cal members with complex medical, behavioral, and social needs. You'll work directly with individuals experiencing housing insecurity, chronic illness, or behavioral-health challenges helping them navigate care, access community resources, and achieve stability in health and housing. This is a field-based / remote role ideal for professionals who value flexibility and meaningful impact. What you'll do Conduct outreach, assessments, and individualized care plans for ECM and CS members. Coordinate medical, behavioral, and social-service supports-including housing navigation and tenancy services. Complete timely documentation and progress tracking in APF systems. Provide in-person, telephonic, and virtual encounters based on member needs. Collaborate with health plans, community partners, and APF multidisciplinary teams. Maintain strict confidentiality and compliance with Medi-Cal, DHCS, and ILS guidelines. Compensation Base Salary (Straight-Time Pay) Salary is based on your caseload and is calculated using a simple, transparent formula: Each member = 2 paid hours per member per month (PMPM), at $25.00/hour ($50 PMPM) Your monthly salary increases as your caseload increases. Incentive Pay (Additional Earnings) You earn $40 per member per month for delivery qualified, on top of your base salary. Bringing total compensation to $90 PMPM, equivalent to $45/hour Reimbursements & Stipends Mileage reimbursement at the IRS rate $50/month phone stipend Reimbursement for approved work-related expenses Schedule Work hours are flexible and self-directed, provided Care Managers meet service delivery requirements and member availability Qualifications Minimum 2 years of experience in case management, care coordination, or related field Knowledge of Medi-Cal CalAIM programs, community resources, and social determinants of health Excellent documentation, organization, and communication skills Valid California Driver's License, auto insurance, and reliable transportation Preferred: Bachelor's degree or CHW certification; CA licensure (LCSW, LMFT, LPCC, RN, etc.)

Benefits: Job you will love Fulfilling work Rewarding Career Supportive Environment Make a difference for your clients In Demand The Care Manager is responsible for providing quality professional care management services to all clients and their responsible parties. Our objective is to assist our clients in managing and navigating challenges in aging as well as Adults with physical and mental disabilities and providing the highest quality of life. This includes: Care Coordination Managing home health aides Medical oversight Interfacing with medical personnel Advocacy, information and referrals Qualifications: Professional and positive approach, commitment to customer service Self-motivated and work with own initiative Strong in building relationships, team player and able to communicate at all levels Recognizes industry trends and problem solves Respectful of company and client confidentiality; any violation of company or client confidence is immediate grounds for dismissal. Personalized and compassionate service - focusing on the individual client's wants and needs. Ability to provide non-directive guidance and facilitate constructive relationships. Ability to ensure inappropriate placements, duplication of services, and unnecessary hospitalizations are avoided. Manage time efficiently. Ability to provide coordinated communication between family members, doctors and other professionals, and service providers. This is a remote position. Aging Life Care Professionals offer a holistic, client-centered approach to caring for older adults or others facing ongoing health challenges. Working with families, the expertise of Aging Life Care Professionals provides the answers at a time of uncertainty. Their guidance leads families to the actions and decisions that ensure quality care and an optimal life for those they love, thus reducing worry, stress and time off of work for family caregivers through: Assessment and monitoring Planning and problem-solving Education and advocacy Family caregiver coaching This business is independently owned and operated. Your application will go directly to the business, and all hiring decisions will be made by the management. All inquiries about employment at this business should be made directly and not to Aging Life Care Association.

Job Description Patient Care Manager (Hybrid) Inland Empire, CA This position is full-time and remote (Must be available for in-person interactions as needed) We are seeking a full-time Patient Care Manager who lives in Inland Empire and works remotely assisting patients with education and assessment of their ongoing care management. The focus of assistance is in enhancing the quality of patient management, maximizing patient satisfaction, promoting cost-effectiveness, and increasing the efficacy of addressing healthcare disparities. We specialize in engaging and caring for the top 1% highest utilizing Medicaid patients . We are looking for empathetic professionals that are enthusiastic about this population with a focus of care from that person's perspective. Compensation and Benefits for Patient Care Manager Compensation: $60,000 - $70,000 annually 3 weeks (2 weeks + 6-7 federal holidays) paid time away and 401K Medical, Dental, and Vision benefits. Responsibilities for Patient Care Manager Assistant patients with various financial and economic needs Update team with important issues to patient needs that assist with overall health Stay up to date with knowledge in this space Qualifications for Patient Care Manager Bachelor's Degree (preferred) Associates Degree (required) 1+ Years in outpatient Behavioral Health field and/or Social Support field 2+ Years in direct care management position conducting biopsychosocial assessments and care plan development (preferred) Understanding of how to navigate the Federal and State programs. Must possess a good understanding of disability, food stamps, and IHSS Comfortable managing more than 80 patients Bilingual (preferred) For more healthcare opportunities, go to: ************************************************ #MASC105

The Care Manager's role is to work in partnership with individuals with I/DD, their family/guardian, and providers to coordinate care and services needed to assist individuals achieve optimal health, wellness, independence, community integration and accomplishing goals. The Care Manager is responsible for providing Health Home core services including comprehensive care management, care coordination and health promotion, comprehensive transitional care, individual and family support, referral to community and social support services, and use of Health Information Technology to link services. Care Managers will provide all services with a person-centered approach. Essential Job Functions: Conduct comprehensive assessments to identify an individual's clinical and psychosocial needs, choices, and preferences for services Assess and address health and safety issues as well as barriers to care and treatment including social determinants of health Collaborate with interdisciplinary team and incorporate input into comprehensive assessment and the person's Life Plan Facilitate, develop, and maintain a person-centered Life Plan that integrates an individual's personal wants and needs, clinical and non-clinical healthcare related needs, community services, OPWDD services, and natural supports. Incorporate health promotion and support opportunities for individuals to achieve and maintain optimal health and wellbeing Adhere to Incident Management regulations, guidelines, and policies and procedures Coordinate and ensure access to chronic disease management Facilitate referrals to clinical and community resources, including planning, implementation, and follow-up for comprehensive care management and transitional care Participate in internal and external audits Coordinate and provide access to long-term care supports and services Engage families and natural supports in the care coordination process Provide all individuals and families with services that are culturally and linguistically appropriate Advocate on behalf of the individual Promote self-advocacy and the ability to self-direct Use Health Information Technology for documentation, to link services, and facilitate communication among care coordination team Secure all health records and other protected information with the highest regard to confidentiality and HIPAA laws and regulations Maintain compliance with all state and federal laws and regulations, Medicaid compliance, and PCC policies and procedures Document all services and maintain appropriate records following all established documentation policies and procedures Complete all required training including annual, ongoing, and educational trainings Perform all other duties relevant to the position as requested. Knowledge, Skills, and Abilities Ability to act quickly, assess and act accordingly in crisis situations Intermediate technology skills in Outlook, Teams, Word, Excel, online applications as needed Understanding use of an EHR system Knowledge of ethical and professional responsibilities and boundaries Demonstrate professional work habits including dependability, time management, organization, autonomy, and productivity Education and Experience: Bachelor's degree with two years of relevant experience OR A license as a Registered Nurse with two years of relevant experience, which can include any employment experience and is not limited to case management/service coordination duties OR A Master's degree with one year of relevant experience. Position require bi-lingual skills - fluency in Spanish Physical Requirements/Working Conditions: Ability to sit/stand throughout day to accomplish job Ability to enter data, notes, and other documentation into a computer. Must be able to travel throughout covered territories in Upstate NY as needed. Must have a valid driver's license Ability to conduct in-person visits and meetings at individuals homes, communities, schools, and other locations as applicable Ability to work remotely, satellite office locations, and/or primary office location Corporate Qualifications/Expectations: Adhere to all Prime Care Coordination policies and procedures. Adhere to the Agency Mission, Vision, Shared Values, and Customer Service Standards. Attend mandatory education and training modules as scheduled; obtain and maintain required certifications. Maintain all required certifications/training by State regulations and PCC policy Act as a professional representative of PCC in regard to appearance, behavior, temperament, communication, language, and dress.

Hello, how are you? Are you a LPN that is looking to improve the health of patients that have complex conditions? Do you live within a reasonable driving distance to St. Joseph, MO? Would you like to work from home and travel for the training/occasional meetings? If you answered yes to the above and have/are: Savvy with basic software/services such as email, word, excel, etc. Detail oriented to the point of annoying people because you pick up on things that others don't. Partial to helping people that are unappreciated, overlooked, and may not have any other types of support. A solid home/office environment that enables you to get the job done correctly whenever it needs to be done. Naturally competitive and want to win. YOU want to be the best and enjoy working with others who are the same. An active LPN license that is in good standing. ****1000 imaginary bonus points if you have long-term care, skilled nursing, assisted living, care management, or other experience working with patients who have chronic conditions.**** At SparroWell, we want to win by helping others get the best care possible. Our awesome team works with physicians, nurse practitioners, and other clinical team members that specialize in taking care of people with chronic illnesses. Our advanced care team also supports patients, families, as well as their caregivers to provide additional resources whenever needed. On any given day, our team is coordinating care, reviewing medications, auditing charts like a BOSS, collaborating with medical providers, and ultimately making a difference in the lives of patients we serve. We work from home but do occasionally meet in person for meetings and training on the latest requirements/guidelines. Go ahead, start the conversation by sending us your resume today. We will consider all applicants even though we prefer to work with nurses that have long-term care or post-acute experience. If you would like to learn more about our company, please visit us at **************************** Thank you for reviewing our opportunity and we look forward to hearing from you.

Overview As a Care Design New York Care Manager, you will help people with intellectual and/or development disabilities identify and realize their long-term and short-term goals by developing, implementing, and monitoring their person-centered Life Plans. These plans help our members live their best life - so we'll count on your best relational and organizational skills. Our Care Managers may come from different walks of life, but all receive the best training in the profession. You will plug your passion for service into our model of care to deliver the highest standard of service to our members. This dynamic position is performed in a hybrid environment that includes required visits with members you support and their families in their home, attending periodic trainings and meetings in the office, and working from home. If you support our members outside of New York City, you will need a driver's license, reliable transportation and appropriate insurance. Our membership is diverse and so is our workforce. We welcome bilingual candidates who can support that diversity and we may provide ADDITIONAL COMPENSATION for fluency in English and languages such as Spanish, Korean, Mandarin, Cantonese, Russian, Hindi, Bengali, Urdu, Yiddish, Hebrew, and ASL. All full-time positions come with generous benefits including: health, vision and dental insurance, paid time off, $3000 tuition reimbursement per calendar year, and up to $250 of professional development courses! CDNY is also a qualifying employer under the Public Service Loan Forgiveness (PSLF) program. Click here to view our current benefits summary. Responsibilities * Responsible for advocating for and with our members to ensure informed decision making, informed consent, and appropriate guardianship. * Responsible for scheduling, leading and actively collaborating with our members and their interdisciplinary team to conduct meetings and assessments ensuring the development of a comprehensive, person-centered Life Plan that reflects the person's needs and desired life goals. * Implement, update, and monitor Life Plans and facilitate individualized Life Plan reviews and approval processes. * Ensure integration of all needed and preferred supports and services (i.e., medical, behavioral, social, habilitation, dental, psychosocial, and community-based, and facility-based long-term supports and services, etc.). * Maintain ongoing contact with the critical people in a member's life. * Ensure timely submission of all documentation (Life Plan, Progress notes, etc.) * Assist our members with maintaining benefits such as Social Security, Supplemental Security Income, Medicaid and Medicare coverage, and Food Stamps. * Assist members to resolve problems in living such as housing, utilities, the judicial system, and general safety. * Report abuse or neglect immediately when observed or reported. * A comprehensive job description may be provided during the interview process Qualifications Care Managers who serve individuals with I/DD must meet the following qualifications: * A Bachelor's degree with 2+ years of relevant experience, OR * A License as a Registered Nurse with 2+ years of relevant experience, which can include any employment experience and is not limited to case management/service coordination duties, OR * A Master's degree with 1+ year of relevant experience. * Strong communication skills, including verbal and written communication skills, along with strong interpersonal and organizational skills also required. * Excellent organizational, interpersonal, and verbal and written communication skills required. Care Design NY and Partnership Solutions provide equal employment opportunities to all. We celebrate the qualities that make each of us unique and greatly value how they enrich the work we do. As such, we welcome candidates of color, candidates who identify as gender diverse, neurodiverse candidates, and candidates of all ages with diverse lived experiences and perspectives to apply. Salary starting at $27.75 / hour Salary up to $28.41 / hour

Benefits: 401(k) Flexible schedule Opportunity for advancement Job Title: Remote Care ManagerLocation: Remote (Must reside in the Contra Costa county) Organization: Cecilia Holistic & Wellness CenterEmployment Type: Full-Time About Us:Cecilia Holistic & Wellness Center is a community-rooted organization committed to bridging the gap in care by providing wraparound support services that promote wellness, stability, and self-sufficiency. We serve individuals and families with compassion, respect, and a holistic approach to care. Position Overview:We are looking for a dedicated, organized, and tech-savvy Care Manager to join our remote team. This position requires a deep commitment to community service and holistic wellness. While the role is fully remote, candidates must reside in the servicing county and be available for light local travel and driving for client visits, assessments, or community events. Responsibilities: Conduct virtual or in-person assessments to identify client needs and goals Develop individualized care plans and provide ongoing case management Coordinate services across housing, healthcare, employment, and wellness resources This is a remote position. Compensation: $17.50 - $25.00 per hour The Full Story About Mission Cecilia Holistic & Wellness Center has been actively engaged in the community, providing various holistic and wellness services to promote overall well-being. They have been dedicated to helping individuals achieve physical, mental, and emotional balance through their services. The center has actively participated in community events, workshops, and seminars to educate the community about the benefits of holistic practices. They have conducted free wellness sessions, meditation classes, and yoga workshops to promote mindfulness and stress reduction. Cecilia Holistic & Wellness Center has also collaborated with local organizations and healthcare providers to offer services to underprivileged individuals and promote health equity in the community. They have organized health fairs, where they provide free health screenings and consultations. In addition to their existing services, Cecilia Holistic & Wellness Center is eager to expand their offerings to better serve the community. They are planning to introduce new programs such as nutritional counseling, doulas, and alternative therapy options. These additional services aim to address specific health needs and provide a comprehensive approach to holistic well-being. With their commitment to community engagement and their willingness to offer more services, Cecilia Holistic & Wellness Center continues to play an active role in promoting a healthier and more balanced lifestyle within the community.

This position consists of weekly in-person Care Management visits with the client, coordination with PCP and telephonic contact to ensure adherence to treatment plan. Also must be available to answer questions that the client may have between visits. During the visit CM will gather information and educate the patient on his or her disease management, medication administration, and home safety in order to the client remain safely at home. CM will assist patient and/or family member to connect with other needed resources such as meals, transportation to PCP, and insuring that all prescribed medications are in the home. At all times the Director of Healthcare Operations is available as a resource to CM. Requirements Must have at least 1 year verifiable experience as a RN, LPN or Social Worker Must have an active professional license in your state. Must have a good driving record, auto insurance, a reliable vehicle Must have internet access for visit and assessment logging Must be a dependable person The applicant must not have Disciplinary Actions against their professional license or be listed in the List of Excluded Individuals/Entities Search Responsibilities The RN, LPN or Social Worker will also be required to enter all assessment and visit information into the online system within 24 hours of the visit. Upon hire and prior to the first visit, a short online training session and webinar will need to be completed. You will be required to visit the client once a week, 4 times a month on going. Flexible schedule. Work from home.

Job DescriptionBenefits: 401(k) Health insurance Are you an experienced RN with a passion for geriatric care? Join our team as a Full-Time RN Care Manager! Were looking for a compassionate, skilled professional with strong clinical judgment and excellent communication abilities. The ideal candidate will thrive in a collaborative, interdisciplinary environment working alongside physicians, nurses, social workers, and mid-level providers. Requirements: - Experience in geriatric care - Strong clinical and communication skills - Ability to work effectively within a team - Reliable transportation and willingness to travel throughout Monroe County and surrounding areas We offer competitive pay and the opportunity to make a real difference in patients lives. For more information or to apply, please call ************ today! Job Type: Full-time Pay: From $32.00 per hour Work Location: Hybrid remote in Monroe County, NY Flexible work from home options available.

LOCATION: Remote - must live in or near McDowell County, North Carolina. The person in this position must maintain residency in North Carolina or within 40 miles of the North Carolina border. This position requires travel. GENERAL STATEMENT OF JOB The Care Manager is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members and recipients (“members”) to ensure that these individuals receive appropriate assessment and services. The Care Manager works with the member and care team to alleviate inappropriate levels of care or care gaps through assessment, multidisciplinary team care planning, linkage and/or coordination of services needed by the member across the MH, SU, intellectual/ developmental disability (“I/DD”), traumatic brain injury (“TBI”) physical health, pharmacy, long-term services and supports (“LTSS”) and unmet health-related resource needs networks. Care Managers support and may provide transition planning assistance to state, and community hospitals and residential facilities and track individuals discharged from facility settings to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalization. This is a mobile position with work done in a variety of locations, including members' home communities. The Care Manager also works with other Vaya staff, members, relatives, caregivers/ natural supports, providers, and community stakeholders. As further described below, essential job functions of the Care Manager include, but may not be limited to: Utilization of and proficiency with Vaya's Care Management software platform/ administrative health record (“AHR”) Outreach and engagement Compliance with HIPAA requirements, including Authorization for Release of Information (“ROI”) practices Performing Health Risk Assessments (HRA): a comprehensive bio-psycho-social assessment addressing social determinants of health, mental health history and needs, physical health history and needs, activities of daily living, access to resources, and other areas to ensure a whole person approach to care Adherence to Medication List and Continuity of Care processes Participation in interdisciplinary care team meetings, comprehensive care planning, and ongoing care management Transitional Care Management Diversion from institutional placement This position is required to meet NC Residency requirements as defined by the NC Department of Health and Human Services (“NCDHHS” or “Department”). This position is required to live in or near the counties served to effectively deliver in-person contacts with members and their care teams. ESSENTIAL JOB FUNCTIONS Assessment, Care Planning, and Interdisciplinary Care Team: Ensures identification, assessment, and appropriate person-centered care planning for members. Links members with appropriate and necessary formal/ informal services and supports across all health domains (i.e., medical, and behavioral health home) Meets with members to conduct the HRA and gather information on their overall health, including behavioral health, developmental, medical, and social needs. Administer the PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings within their scope based on member's needs. The Care Manager uses these screenings to provide specific education and self-management strategies as well as linkage to appropriate therapeutic supports. The assessment process includes reviewing and transcribing member's current medication and entering information into Vaya's Care Management platform, which triggers the creation of a multisource medication list that is shared back with prescribers to promote integrated care. Supports the care team in development of a person-centered care plan (“Care Plan”) to help define what is important to members for their health and prioritize goals that help them live the life they want in the community of their choice. Ensure the Care Plan includes specific services to address mental health, substance use, medical and social needs as well as personal goals Ensure the Care Plan includes all elements required by NCDHHS Use information collected in the assessment process to learn about member's needs and assist in care planning Ensure members of the care team are involved in the assessment as indicated by the member/LRP and that other available clinical information is reviewed and incorporated into the assessment as necessary Work with members to identify barriers and help resolve dissatisfaction with services or community-based interventions Reviews clinical assessments conducted by providers and partners with Care Manager - LP and Care Manager Embedded - LP for clinical consultation as needed to ensure all areas of the member's needs are addressed. Help members refine and formulate treatment goals, identifying interventions, measurements, and barriers to the goals Ensures that member/legally responsible person (“LRP”) is/are informed of available services, referral processes (e.g., requirements for specific service), etc. Provides information to member/LRP regarding their choice of service providers, ensuring objectivity in the process Works in an integrated care team including, but not limited to, an RN (Registered Nurse) and pharmacist along with the member to address needs and goals in the most effective way ensuring that member/LRP have the opportunity to decide who they want involved Supports and may facilitate care team meetings where member Care Plan is discussed and reviewed Solicits input from the care team and monitor progress Ensures that the assessment, Care Plan, and other relevant information is provided to the care team Reviews assessments conducted by providers and consults with clinical staff as needed to ensure all areas of the member's needs are addressed Updates Care Plans and Care Management assessment at a minimum of annually or when there is a significant life change for the member Supports and assists with education and referral to prevention and population health management programs. Works with the member/LRP and care team to ensure the development of a Care Management Crisis Plan for the member that is tailored to their needs and desires, which is separate and complementary to the behavioral health provider's crisis plan. Provides crisis intervention, coordination, and care management if needed while with members in the community. Supports Transitional Care Management responsibilities for members transitioning between levels of care Coordinates Diversion efforts for members at risk of requiring care in an institutional setting Consults with care management licensed professionals, care management supervisors, and other colleagues as needed to support effective and appropriate member care. Collaboration, Coordination, Documentation: Serves as a collaborative partner in identifying system barriers through work with community stakeholders. Manages and facilitates Child/Adult High-Risk Team meetings in collaboration with DSS, DJJ, CCNC, school systems, and other community stakeholders as appropriate. Works in partnership with other Vaya departments to identify and address gaps in services/ access to care within Vaya's catchment. Participates in cross-functional clinical and non-clinical meetings and other projects as needed/ requested to support the department and organization. Participates in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs, providing support to other CMs (Care Manager) and receiving support and feedback regarding CM interventions for clients' medical, behavioral health, intellectual /developmental disability, medication, and other needs. Works with Care Manager - LP and Care Manager Embedded - LP in participating in other high risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system. Monitors provision of services to informally measure quality of care delivered by providers and identify potential non-compliance with standards. Ensures the health and safety of members receiving care management, recognize and report critical incidents, and escalate concerns about health and safety to care management leadership as needed. Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other stakeholders. Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues. Supports and assists members/families on services and resources by using educational opportunities to present information. Verifies member's continuing eligibility for Medicaid, and proactively responds to a member's planned movement outside Vaya's catchment area to ensure changes in their Medicaid county of eligibility are addressed prior to any loss of service. Proactively and timely creates and monitors documentation within the AHR to ensure completeness, accuracy and follow through on care management tasks. Maintains electronic AHR compliance and quality according to Vaya policy. Works with Care Manager - LP and Care Manager Embedded - LP to ensure all clinical and non-clinical documentation (e.g. goals, plans, progress notes, etc.) meet all applicable federal, state, and Vaya requirements, including requirements within Vaya's contracts with NCDHHS. Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies. Other duties as assigned. KNOWLEDGE, SKILLS, & ABILITIES Ability to express ideas clearly/concisely and communicate in a highly effective manner Ability to drive and sit for extended periods of time (including in rural areas) Effective interpersonal skills and ability to represent Vaya in a professional manner Ability to initiate and build relationships with people in an open, friendly, and accepting manner Attention to detail and satisfactory organizational skills Ability to make prompt independent decisions based upon relevant facts. Well-developed capabilities in problem solving, negotiation, arbitration, and conflict resolution, including a high level of diplomacy and discretion to effectively negotiate and resolve issues with minimal assistance. A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change Thorough knowledge of standard office practices, procedures, equipment, and techniques and intermediate to advanced proficiency in Microsoft office products (Word, Excel, Power Point, Outlook, Teams, etc.), and Vaya systems, to include the care management platform, data analysis, and secondary research Understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) within their scope and have considerable knowledge of the MH/SU/IDD/TBI service array provided through the network of Vaya providers. Experience and knowledge of the NC Medicaid program, NC Medicaid Transformation, Tailored Plans, state-funded services, and accreditation requirements are preferred. Ability to complete and maintain all trainings and proficiencies required by Vaya, however delivered, including but not limited to the following: BH I/DD Tailored Plan eligibility and services Whole-person health and unmet resource needs (ACEs, trauma-informed care, cultural humility) Community integration (independent living skills; transition and diversion, supportive housing, employment, etc.) Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc.) Health promotion (common physical comorbidities, self-management, use of IT, care planning, ongoing coordination) Other care management skills (transitional care management, motivational interviewing, person-centered needs assessment and care planning, etc.) Serving members with I/DD or TBI (understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc.) Serving children (child-and family-centered teams, Understanding the “System of Care” approach) Serving pregnant and postpartum women with SUD or with SUD history Serving members with LTSS needs (Coordinating with supported employment resources Job functions with higher consequences of error may be identified, and proficiency demonstrated and measured through job simulation exercises administered by the supervisor where a minimum threshold is required of the position. EDUCATION & EXPERIENCE REQUIREMENTS Bachelor's degree required, preferably in a field related to health, psychology, sociology, social work, nursing or another relevant human services area. Serving members with BH conditions: Two (2) years of experience working directly with individuals with BH conditions Serving members with LTSS needs Two (2) years of prior Long-term Services and Supports (LTSS) and/or Home Community Based Services (HCBS) coordination, care delivery monitoring and care management experience. This experience may be concurrent with the two years of experience working directly with individuals with BH conditions, an I/DD, or a TBI, described above --If graduate of a college or university with a Bachelor's degree in Human Services, then incumbent must have two years of full-time accumulated experience in mental health with population served. --If graduate of a college or university with a Bachelor's degree is in field other than Human Services, then incumbent must have four years of full-time accumulated experience in mental health with population served. --If a graduate of a college or university with a Bachelor's Degree in Nursing and licensed as RN, then incumbent must have four years of full-time accumulated experience in mental health with population served. Experience can be before or after obtaining RN licensure. --If graduate of a college or university with a Master's level degree in Human Services, although only one year of experience is needed to reach QP status, the incumbent must still have at least two years of full-time accumulated experience in mental health with the population served *Must meet the criteria of being a North Carolina Qualified Professional with the population served in 10A NCAC 27G .0104 Licensure/Certification Required: If Incumbent has a Bachelor's degree in nursing and RN, incumbent must be licensed by the North Carolina Board of Nursing to practice in the State of North Carolina. Preferred work experience: Experience working directly with individuals with I/DD or TBI PHYSICAL REQUIREMENTS Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists, and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work. Ability to drive and sit for extended periods of time (including in rural areas) RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border. SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation. DEADLINE FOR APPLICATION: Open Until Filled APPLY: Vaya Health accepts online applications in our Career Center, please visit ****************************************** Vaya Health is an equal opportunity employer.