Care Manager

3 weeks ago


Topeka, Kansas, United States Sunflower Health Plan Full time
Job Title: LTSS Service Care Manager

Sunflower Health Plan is seeking a skilled LTSS Service Care Manager to join our team. As a key member of our care management team, you will play a critical role in ensuring our members receive high-quality, cost-effective care.

Job Summary:

The LTSS Service Care Manager will be responsible for developing, assessing, and coordinating holistic care management activities for members with significant mental/behavioral health needs. This includes evaluating member service needs, developing or contributing to care plans, and educating members, their families, and caregivers on services and benefits available to meet member needs.

Key Responsibilities:
  • Evaluate the needs of complex and high-risk members with mental/behavioral health needs and recommend a plan of care for optimal outcomes.
  • Act as a liaison and member advocate between the member/family, physician, and facilities/agencies.
  • Support members with primarily mental/behavioral health needs, such as those with major depression, bipolar disorders, schizophrenia, borderline personality disorder, post-traumatic stress disorder, substance use disorder, self-injurious behavior, psychiatric inpatient admissions, etc.
  • Perform frequent home and/or other site visits to assess member needs and collaborate with resources, as required.
  • Provide education to long-term care members and their families/caregivers on topics such as preventive care, procedures, healthcare provider instructions, treatment options, referrals, prescribed medication treatment regimens, and healthcare benefits.
  • Educate on and coordinate community resources, including medical, behavioral, and social services. Provide coordination of service authorization to members and care managers for various services based on service assessment and plans.
  • Ensure appropriate referrals based on individual member needs and support the identification of providers, specialists, and community resources. Ensure identified services are accessible to members.
  • Maintain accurate documentation and support the integrity of care management activities in the electronic care management system. Work to ensure compliance with clinical guidelines as well as current state and federal guidelines.
  • Provide feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.
Requirements:
  • Master's degree in Mental Health or Social Work or Graduate from an Accredited School of Nursing and 2 – 4 years of related experience.
  • Licensed Behavioral Health Professional or RN based on state contract requirements, e.g., LCSW, LMFT, LMHC, LPC, and RN with BH experience required.

Sunflower Health Plan offers a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Sunflower Health Plan is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


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