Government Programs Care Manager III

This is a fully remote position, open to applicants in New Mexico.

📋 Description

• Deliver care coordination to members through telephonic and/or field-based management.

• Educate and inform members about healthcare programs tailored to their individual health requirements.

• Engage members in conversations about their adherence to personal health objectives.

• Address inquiries from members promptly.

• Assist clinical operations with activities involving providers and members.

• Conduct member health screenings via telephone and/or in the field.

• Perform comprehensive health assessments and develop care plans.

• Visit members’ residences and/or facilities as necessary to support complex and specialty populations.

• Discuss clinical matters with both members and physicians.

• Collaborate with internal staff, management, external vendors, and community resources.

• Travel within the designated territory as required.

⛳️ Requirements

• Registered Nurse (RN) with a minimum of 2 years of direct clinical care experience in a clinical environment, or possess an applicable unrestricted behavioral-health license with 2 years of clinical practice.

• Hold a current, valid, unrestricted license in the operational state (or through reciprocity).

• Plus 3 years of experience in wellness or managed care, addressing clinical issues with members and physicians.

• Understanding of the health and wellness market and employer trends.

• Strong verbal and written communication skills.

• Analytical skills, including experience with medical data analysis.

• Proficient in PC applications, including Word, Excel, and PowerPoint.

• Experience with databases and web-based applications.

• Possess a current unrestricted driver’s license, transportation, and applicable insurance.

• Willingness and ability to travel within the assigned territory.

• State-specific waiver qualifications may necessitate credentials/experience in nursing, social work, counseling, psychology, human services, case management, or related fields.

• Preferred: 3 years of direct clinical experience.

• Preferred: Experience in patient education.

• Preferred: Experience in Condition Management.

• Preferred: Bilingual proficiency in English and Spanish.

• Preferred: Experience in managing complex or catastrophic cases.

• Preferred: Certification in Case Management, Training, Project Management, or a nationally recognized healthcare certification.

• Preferred: Experience with Government Programs.

• Preferred: Experience in Population Management.

🏝️ Benefits

• Health and wellness benefits.

• 401(k) savings plan.

• Pension plan.

• Paid time off.

• Paid parental leave.

• Disability insurance.

• Supplemental life insurance.

• Employee assistance program.

• Paid holidays.

• Tuition reimbursement.

• Annual incentive bonus plan.

• Additional incentives.

• Opportunities for professional development.