Lead Care Manager

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Supervise care plans and care management initiatives for members facing intricate behavioral health and social challenges.

• Evaluate and deliver expert insights for tailored care plans.

• Mentor and assist the care management team.

• Identify healthcare providers, specialists, and community resources essential for care.

• Conduct outreach through telephonic, digital, home, and/or other site visits to evaluate member needs.

• Direct complex issues to the appropriate behavioral healthcare providers.

• Ensure quality assurance, service availability, and compliance with contractual policies and procedures.

• Track complex care plans, member status, outcomes, treatment side effects, complications, and clinical symptoms.

• Analyze member data to uncover health risks and care gaps and propose enhancements.

• Collaborate with healthcare providers on intricate cases and updated care plans.

• Gather, document, and maintain member information and care management activities.

• Provide training and educational support to care management teams and providers.

• Collaborate with leadership to enhance cost-effective care and quality service delivery.

• Ensure adherence to corporate, state, and NCQA standards.

• Partner with senior management on escalated cases and provide guidance to junior team members.

• Evaluate reports, monitor quality and productivity metrics, manage case assignments, and conduct staff audits.

• Perform additional duties as assigned and adhere to all policies and standards.

⛳️ Requirements

• Must reside in North Carolina.

• A Master's degree in Behavioral Health or Social Work, or a degree from an accredited nursing school.

• 5–7 years of relevant experience.

• Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN as per state contract requirements, with necessary behavioral health experience.

• Pediatric experience is highly preferred.

• Capability to manage intricate behavioral health and social-needs care plans.

• Familiarity with state and federal regulations, third-party payer requirements, and NCQA standards.

• Approximately 10% travel may be necessary for occasional meetings or team events in Raleigh or Charlotte.

• For the Illinois Youth Care plan: must reside in Illinois and possess a graduate degree along with independent behavioral health licensure, or a bachelor's degree and IL RN licensure.

• For Sunshine Health (FL): must have a master’s degree in social work or a related field, one year of relevant professional pediatric care experience, and hold an LCSW, LMHC, or another Clinical Mental Health Professional license; may require up to 80% local travel.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work approach with options for remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.