Clinical Case Manager Behavioral Health - Work at Home - NY

The Behavioral Health Care Manager is responsible for coordinating, assessing, planning, and managing services for members with behavioral health, medical, and psychosocial needs. This role focuses on supporting individuals with serious mental illness (SMI), substance use disorders (SUD), co-occurring behavioral and physical health conditions, and complex social determinants of health. The Care Manager collaborates with members, caregivers, providers, and community resources to develop person-centered care plans that promote recovery, independence, safety, and improved health outcomes.

The Behavioral Health Care Manager serves as an advocate for members and ensures appropriate access to behavioral health, medical, long-term care, and community-based services while maintaining compliance with Medicaid, Medicare, and regulatory requirements.

Essential Duties and Responsibilities

• Conduct comprehensive psychosocial, behavioral health, and care management assessments.
• Develop, implement, monitor, and update individualized care plans based on member goals, needs, and preferences.
• Coordinate behavioral health, medical, pharmacy, and social support services across multiple providers and settings.
• Identify and address barriers to care, including housing instability, food insecurity, transportation needs, and lack of social support.
• Facilitate referrals and linkage to community resources, behavioral health services, HCBS programs, and supportive services.
• Monitor member progress through regular outreach, care plan reviews, and interdisciplinary case discussions.
• Coordinate transitions of care following hospitalizations, psychiatric admissions, skilled nursing facility stays, emergency department visits, and rehabilitation services.
• Provide crisis intervention support and facilitate appropriate behavioral health referrals as needed.
• Promote recovery-oriented, trauma-informed, and culturally competent care practices.
• Collaborate with psychiatrists, therapists, primary care providers, care management teams, and community partners.
• Educate members and caregivers regarding treatment plans, medication compliance, self-management, and available resources.
• Identify gaps in care and implement interventions to improve member outcomes and quality metrics.
• Participate in interdisciplinary team meetings, utilization reviews, and case conferences.
• Maintain timely and accurate documentation in compliance with organizational, state, federal, Medicaid, Medicare, and accreditation requirements.
• Ensure completion of required assessments, care plans, outreach activities, and regulatory documentation within established timeframes.
• Manage a caseload of members with varying levels of behavioral and medical complexity.

• Master's Degree in Social Work (MSW) from an accredited institution required.

Licensing

• Current New York State Licensed Master Social Worker (LMSW) required.
• Clinical licensure (LCSW) strongly preferred.

Preferred Qualifications

• Experience in Managed Medicaid, Medicare Advantage, Dual Eligible populations, MLTC, Health Home, or Integrated Care programs.
• Knowledge of HCBS, supportive housing, community mental health resources, and long-term services and supports (LTSS).
• Case Management Certification (CCM, ACM, or equivalent).
• Bilingual skills preferred English/Spanish

Knowledge, Skills, and Abilities

• Strong understanding of behavioral health diagnoses, treatment modalities, and recovery principles.
• Knowledge of Medicaid, Medicare, Managed Care, and behavioral health regulations.
• Knowledge of serious mental illness, substance use disorders, crisis intervention, and trauma-informed care.
• Excellent assessment, care coordination, and care planning skills.
• Strong clinical judgment and critical-thinking abilities.
• Ability to effectively engage members with complex psychosocial and behavioral health needs.
• Excellent communication, motivational interviewing, and relationship-building skills.
• Ability to work independently and manage a high-volume caseload.
• Proficiency with electronic medical records and care management platforms.
• Strong organizational skills and attention to detail.

Core Competencies

• Member-Centered Care
• Clinical Assessment
• Behavioral Health Expertise
• Care Coordination
• Crisis Management
• Collaboration and Teamwork
• Regulatory Compliance
• Cultural Competency
• Communication and Engagement
• Problem Solving and Critical Thinking

Performance Expectations

• Timely completion of assessments, care plans, and required member contacts.
• Achievement of member engagement and quality metrics.
• Effective coordination of behavioral health and medical services.
• Compliance with all documentation and regulatory requirements.
• Successful management of high-risk members and transitions of care.
• Contribution to improved member outcomes, reduced avoidable hospitalizations, and enhanced quality of life.