Integrated Care Manager- Eastern Shore

City/State

Work Shift

The Integrated Case Manager, RN is responsible for providing comprehensive case management services within the scope of nursing licensure, focusing on members with behavioral health needs, complex medical conditions, intellectual and developmental disabilities, and those receiving Medicaid waiver services. The Case Manager develops, implements, evaluates, and revises individualized care plans designed to improve health outcomes, promote independence, and enhance quality of life.

This role conducts telephonic and face-to-face assessments to identify, coordinate, and manage members' physical health, behavioral health, social determinants of health, long-term services and supports (LTSS), and community resource needs.

• →Perform comprehensive assessments of members with complex medical, behavioral health, and social needs.
• →Manage a caseload consisting primarily of members enrolled in waiver programs, behavioral health programs, and complex care management initiatives.
• →Develop and maintain individualized care plans that address physical health, behavioral health, long-term services and supports, and social service needs.
• →Coordinate care with members, caregivers, providers, behavioral health professionals, community agencies, and interdisciplinary care teams.
• →Identify members at risk for adverse outcomes and implement interventions to reduce avoidable hospitalizations and emergency department utilization.
• →Facilitate access to waiver services, community resources, behavioral health treatment, and specialty care.
• →Monitor member progress, close gaps in care, and support quality improvement initiatives.
• →Present complex cases during interdisciplinary case conferences and collaborate with Medical Directors, Physician Advisors, Behavioral Health teams, and community partners.
• →Assist with authorization, referral, and service coordination processes in accordance with benefit plans and regulatory requirements.
• →Maintain compliance with all regulatory, accreditation, and organizational policies and procedures.

• Associate Degree in Nursing required
• Bachelor's Degree in Nursing (BSN) preferred

• Active Registered Nurse (RN) license required

• Minimum of three (3) years of clinical nursing experience required
• Experience in care management, case management, behavioral health, managed care, Medicaid populations, waiver services, or community-based care strongly preferred
• Experience working with individuals with complex medical, behavioral health, intellectual/developmental disability, or long-term care needs preferred

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.