We are excited to invite applications from individuals residing in the Northeast Region of NM for this remote position, where you will play a crucial role in managing the care of clients within designated populations. You will engage in assessment, care planning, implementation, coordination, monitoring, and evaluation to achieve both cost-effective solutions and high-quality outcomes. Your responsibilities will primarily involve face-to-face visits with clients in their homes. In this role, you will also encourage the optimal utilization of clinical and financial resources, all aimed at enhancing care quality and member satisfaction. Moreover, you will assist in onboarding and mentoring new team members as needed.

• Deliver comprehensive care coordination for members facing behavioral health challenges, ensuring they receive intensive intervention and oversight through a variety of clinical, social, and community resources.

• Conduct thorough health risk assessments and comprehensive needs evaluations, focusing on psycho-social, physical, medical, behavioral, environmental, and financial aspects.

• Formulate and communicate effective care plans, acting as the primary point of contact to guarantee the proper execution of services – particularly during transitions to home care and community-based resources.

• Implement and monitor strategies designed to enhance health and improve members’ quality of life.

• Craft, document, and execute plans that offer suitable resources addressing social, physical, mental, emotional, spiritual, and supportive needs of members.

• Advocate for members by identifying and resolving gaps in their care.

• Continuously evaluate the effectiveness of care plans through ongoing monitoring.

• Assess and review care plans regularly to spot care gaps and identify trends that could enhance health and quality of life outcomes.

• Gather clinical path variance data highlighting potential areas for improvement in services and care delivery.

• Collaborate closely with members and the interdisciplinary care team to adjust care plans as needed.

• Educate healthcare providers, support staff, members, and their families about the care coordination process and health strategies, emphasizing a member-centric approach.

• Facilitate a collaborative team environment to ensure the effective and economical delivery of high-quality care and services.

• Work alongside the interdisciplinary care team—including members, caregivers, legal representatives, physicians, and support services—to address specific care needs linked to medical, behavioral, social, and community-based challenges. Utilize licensed care coordination staff for complex cases.

• Assist members with any inquiries or issues they may have regarding their care, providers, or delivery systems.

• Maintain professional relationships with external partners, including inpatient, outpatient, and community resources.

• Generate reports aligned with care coordination goals.

  Additional Job Requirements

Responsibilities

To qualify for this role, candidates should have 3-5 years of experience in Social Work, Nursing, or a healthcare-related field, or equivalent relevant experience in lieu of a degree. Proficiency in utilization management, quality assurance, home or facility care, community health, long-term care, or occupational health is essential.

Experience in analyzing trends using decision support systems is beneficial. Solid business management abilities—including cost/benefit analysis, negotiation, and cost containment—are required. Candidates should also possess knowledge of referral coordination to community and private/public resources.

A deep understanding of effective care management and an ability to interpret data is crucial. You must be equipped to make decisions that necessitate significant analysis and original thinking, especially in complex situations where existing policies may not apply.

Candidate must be capable of maintaining comprehensive and accurate enrollee records, and possess strong verbal and written communication skills for effective interactions with clinicians, hospital officials, and service agency contacts.

General Job Information

Grade

22

Work Experience – Required

Clinical, Quality

Work Experience – Preferred

Education – Required

GED, High School

Education – Preferred

Associate, Bachelor’s

License and Certifications – Required

DL – Valid Driver License in State – Other

License and Certifications – Preferred

CCM – Certified Case Manager – Care Management, LCSW – Licensed Clinical Social Worker – Care Management, RN – Registered Nurse, State and/or Compact State Licensure – Care Management

Salary Range

Salary Minimum:

$50,225

Salary Maximum:

$75,335

This salary range reflects the anticipated base salary for this role based on current national trends; however, actual pay will be tailored based on individual skills, experience, education, and other job-related factors permitted by law.

This position may qualify for short-term incentives and a comprehensive benefits package. Magellan provides a wide array of health, life, and voluntary benefits that enhance your physical, mental, emotional, and financial wellbeing.

Magellan Health, Inc. is an Equal Opportunity Employer and maintains a Tobacco-free work environment. We celebrate diversity and are committed to providing equal employment opportunities for all individuals, including veterans and individuals with disabilities. Every employee is expected to understand and adhere to security responsibilities specific to their roles and comply with all applicable legal, regulatory, and internal requirements.