Clinical - Care Manager - J01006

Job Profile Summary:

Position Purpose:
Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder.

Education/Experience:
Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2 – 4 years of related experience.


License/Certification:
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

Responsibilities:
Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs

May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources

Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders

Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members

Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs

Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services

Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators

Provides 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

Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
Performs other duties as assigned.

Complies with all policies and standards.

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”

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Story Behind the Need
What is the purpose of this team? What is driving this need? (ex. Backfill for FTE or CW, new project, business growth) Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?		This team provides comprehensive care management and assessment services for members from age 5 through 15 who have high-risk behavioral health needs. The role includes a specialized focus on supporting children involved with Children's Division, as well as members receiving residential treatment. Care Managers collaborate with families, providers, child welfare professionals, and community partners to coordinate care, address barriers, and promote positive outcomes. This is a fast-paced, fully remote position that requires strong critical thinking, organization, and self-motivation. The driving need for this role is backfilling FTE during their leave of absence.
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?			Connect with members through meaningful outreach, helping them navigate benefits, access resources, and overcome barriers to care. Conduct assessments, support discharge planning, and develop individualized care plans that promote stability, wellness, and better behavioral health outcomes. Metrics: Manage a caseload of 75–90 members, including a minimum of 20% high-complexity cases. Conduct proactive member outreach every 2–4 weeks while maintaining an average of 14 outbound calls per day and achieving a 30% contact success rate. What makes this role unique is the opportunity to serve children and adolescents in the foster care system who often present with complex behavioral health needs and significant life challenges. Care Managers support members ages 5–15 who may be at risk for repeated inpatient, treatment foster care, or residential placements, partnering with families, providers, and child welfare professionals to coordinate care, promote stability, and improve long-term outcomes. Applications Centene – Omni, Trucare, emomed, cyberacccess, impact pro, cca Applications Microsoft – Teams, outlook, one note, excel, word, one drive, sharepoint, google and chrome
Candidate Requirements
Education/Certification	Required: MUST HAVE Master's Degree in Social Work, Counseling, or Behavioral Health				Preferred:
Licensure	Required: Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LP, MUST BE MO )				Preferred:
Years of experience required: 2–4 years of experience in care management, behavioral health, social services, or a related field preferred; experience serving the foster care population is highly valued. Younger pediatric population experience preferred. Disqualifiers: Dr degree/over qualified, position longevity/job hopping (Please state if contract AND IF COMPLETE) Not the right fit for individuals seeking highly structured environments with constant direction, those who are uncomfortable with change, or those who prefer to limit their contributions strictly to assigned responsibilities. This role is best suited for self-motivated professionals who take initiative, adapt quickly, and are committed to making an impact beyond the minimum expectations. Additional qualities to look for: We are looking for someone who genuinely cares about making a difference and understands the impact this work has on the children and families we serve. This role is an opportunity to be part of a team that is committed to continuing our mission of revolutionizing health care services for one of the most vulnerable populations in our state.
Top 3 must-have hard skills stack-ranked by importance			1	Ability to independently utilize available resources, reference materials, and training tools to build knowledge and solve problems. Tech savvy and trouble shooting skills.
			2	Ability to actively engage in conversations while accurately documenting assessments, care coordination activities, and member interactions in real time. Excellent verbal and written skills.
			3	Self-motivated, maintain a high level of engagement in a remote environment, and demonstrate the flexibility to adapt to evolving business needs, workflows, and contractual requirements.
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations			Projected Manager Candidate Review Date:			24-48 hours
			Type of Interviews:			Teams with cameras on
			Required Testing or Assessment (by Vendor):			Agencies perform. Computer literacy – Microsoft office. Typing test – 45 WP – 95%
Next Steps
Do you have any upcoming PTO?			08/25/2026
Colleagues to cc/delegate			Linda McQuary, Manager of Care Management