Care Manager, Child & Adolescent Services - Social Worker

About the role

The Care Manager (Social Worker) is responsible for delivering clinically and psychosocially informed, person-centered care management services to Medicaid members with complex physical, behavioral health, and social determinants of health. This role conducts comprehensive clinical and/or biopsychosocial assessments, manages Transitions of Care (TOC) and other high-risk outreach, develops individualized care plans, and supports members through care coordination, system navigation, and condition management. The Care Manager is a licensed professional who collaborates with interdisciplinary and multi-agency teams to ensure coordinated, high-quality care that improves member engagement, stability, health outcomes, and reduces avoidable utilization. This role requires comfort with outbound outreach, including cold-call engagement of hard-to-reach members, to meet program productivity standards and contractual performance requirements.

Responsibilities

• Perform comprehensive clinical and/or psychosocial assessments for assigned high-risk, medically complex, and high-barrier members.
• Develop, implement, and update individualized care plans addressing medical, behavioral health, psychosocial, and environmental needs.
• Manage transitions of care following hospitalization, emergency department utilization, facility stays, behavioral health transitions, or other acute episodes.
• Complete all required follow-up for transition-of-care and assigned populations within established timelines.
• Conduct ongoing care management, monitoring, and coordination for designated members.
• Identify and address barriers affecting adherence, recovery, stabilization, and follow-up, including housing, transportation, food insecurity, caregiver support, financial strain, behavioral health, and substance use concerns.
• Coordinate care with PCPs, specialists, behavioral health providers, facilities, caregivers, interdisciplinary teams, and community agencies.
• Connect patients to community resources, social services, behavioral health resources, and support programs.
• Provide patient and caregiver education related to disease management, self-management, care navigation, resource access, and next steps in care.
• Utilize motivational interviewing, engagement strategies, and de-escalation techniques to support member participation and goal attainment.
• Escalate urgent clinical, psychosocial, crisis, safety, or member-protection concerns appropriately.
• Collaborate with interdisciplinary teams to support integrated, person-centered care delivery.
• Maintain timely, accurate, and compliant documentation across assessments, care plans, outreach, follow-up, and coordination activities.
• Maintain a high level of confidentiality and ensure compliance with HIPAA regulations.
• Assist with planning, coordinating, and representing the organization at community events designed to retain existing members and generate awareness among prospective members.
• Deliver educational presentations to existing and prospective members at community events, clinics, and partner sites; evening and weekend availability is required to support scheduled events and community programming.
• Other duties as assigned.

Qualifications

Education: Active Master of Social Work (MSW) with active applicable licensure in good standing. Must be licensed in the state where the assigned population is served.

Experience: 1+ years of experience in care management, care coordination, case management, behavioral health, social work, utilization management, transitional care, or related experience. Experience working with high-risk, medically complex, behavioral health, or psychosocially complex populations. Experience supporting transitions of care. Preferred experience: Experience with Medicare Advantage, Medicaid, DSNP, and/or CSNP populations. Experience in value-based care, managed care, or population health. Case management certification or related credential. Bilingual capability, where relevant to market needs.

Knowledge, Skills, Abilities: Knowledge of community resources and behavioral health supports. Proficiency with EMR and care-management documentation systems. Complete assessments, care plans, outreach, and follow-up activities within required timelines. Complete transition-of-care follow-up within organizationally defined timeframes. Maintain timely and compliant documentation across all care management activities. Meet expectations related to care-plan completion, case progression, barrier resolution, and member engagement. Escalate urgent or deteriorating clinical, psychosocial, or safety concerns promptly. Meet role-specific LPIs/productivity expectations and delegated responsibilities. Strong clinical and/or psychosocial assessment and intervention skills. Strong care planning and coordination capability. Knowledge of behavioral health, community-resource systems, and social determinants of health. Strong crisis support and de-escalation ability. Ability to manage medically complex and high-barrier patients across settings. Strong communication and collaboration with providers, caregivers, and interdisciplinary teams. Motivational interviewing and patient engagement skills. Strong documentation, follow-through, and compliance discipline. Ability to prioritize risk and intervene appropriately. Ability to manage sensitive and complex cases professionally.

Work environment: Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by company policies and procedures.

Benefits

• Medical, dental, and vision insurance
• 401(k)
• Paid time off (PTO)
• Employee Assistance Program (EAP)

Eligible for annual bonus based on individual and/or company performance.

Pay

Salary Range: $63,502.40‑ $81,000