New 
Care Manager - J01006
 Spectraforce Technologies | |
 United States, North Carolina, Raleigh | |
| 500 West Peace Street (Show on map) | |
 Sep 05, 2025 | |
| 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, costeffective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder. EducationExperience:Requires a Masters degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2 4 years of related experience.LicenseCertification:Licensed Masters Behavioral Health Professional e.g., LCSW, LMSW, LMFT, LMHC, LPC or RN based on state contract requirements with BH experience requiredFor Illinois Youth Care plan only: Graduate degree and independently licensed behavioral health clinician e.g. LCSW, LCPC, PsyD in Illinois or Bachelors Degree and IL RN licensure. Must reside in IL requiredFor NJ Health Plan Only: Requires a Masters degree in Behavioral Health or Social Work and a Licensed Associate Counselor LAC or Licensed Social Worker LSW requiredFor Sunshine Health FL Only: Employees supporting Floridas Childrens Medical Services must Hold a Masters 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 inhome visits related to the resources available, and recommends andor facilitates the care planservice plan for the best outcome, which may include behavioral health and social determinant needsMay perform telephonic, digital, home andor other site visits outreach to assess member needs and collaborate with resourcesDevelops 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 disordersCoordinates as appropriate between the member andor familycaregivers, community resources, and the care provider team to ensure identified services are accessible to membersMonitors care plansservice plans andor member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care planservice plan based on identified member needsFacilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or servicesCollects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and thirdparty payer regulatorsProvides 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 needsProvides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a costeffective mannerPerforms other duties as assigned.Complies with all policies and standards. | |