Clinical Case Manager – Behavioral Health, Commercial Plan

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Job Description:

  • Conduct holistic assessments using clinical tools and data insights to understand each member’s needs
  • Develop tailored care plans by integrating benefit information and both internal and external resources
  • Apply advanced clinical judgment to address risk factors and guide members toward improved health outcomes
  • Provide skilled crisis intervention for members experiencing behavioral health or medical emergencies
  • Coordinate follow-up care to ensure members connect with appropriate providers and services
  • Collaborate closely with providers, supervisors, Medical Directors, and additional programs to reduce barriers and optimize care
  • Apply clinical guidelines, criteria, and policies to support high-quality, medically appropriate care
  • Use motivational interviewing and engagement strategies to empower members and encourage healthy behavior change
  • Educate and coach members to participate confidently in their health decisions
  • Monitor progress using clinical, self-reported, and utilization data to continuously refine care plans
  • Develop, track, and adjust individualized plans of care based on member goals
  • Maintain compliance with accreditation standards and company policies using case management and quality management processes
  • Ability to multitask effectively—including typing and talking with members simultaneously

Requirements:

  • Master’s degree in a behavioral health field
  • Minimum 3 years of post-master’s direct clinical experience (hospital, outpatient, ambulatory, or similar care settings)
  • Strong knowledge of mental health and substance use disorders
  • Experience with Motivational Interviewing
  • Solid technological skills and comfort using digital tools in a remote environment
  • Active, unrestricted, and independent behavioral health license in your state of residence

Benefits:

  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost wellness screenings
  • Tobacco cessation and weight management programs
  • Confidential counseling and financial coaching
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access
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