Job Title: Remote Case Manager

Location: Albuquerque/Rio Rancho area, with potential support in Santa Fe, Grants, and Los Lunas, NM
Schedule: Monday to Friday, 8 AM to 5 PM Mountain Time

Job Description:

We are seeking a Remote Case Manager to join our Managed Care Organization. The Case Manager will work from home but will travel as needed to conduct field visits at member residences, which may include homes, assisted living facilities, shelters, and other settings. This position requires candidates to live in the state of New Mexico. If licensed, candidates must hold a New Mexico license.

Job Summary:

The Case Manager collaborates with members, providers, and a multidisciplinary team to assess, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care. The goal is to help members progress toward desired outcomes through quality care that is both medically appropriate and cost-effective, tailored to the severity of illness and site of service.

Job Qualifications:

Required Education:

• Bachelor's or Master's Degree (preferably in social science, psychology, gerontology, public health, social work, or a related field)

Required Experience:

• 1-3 years in case management, disease management, managed care, or in a medical or behavioral health setting

Required License, Certification, Association:

• Valid driver’s license with a good driving record and reliable transportation

State-Specific Requirements:

• Bachelor’s Degree or a minimum of 1 year of Care Coordination experience

Preferred Experience:

• 1-2 years in case management, disease management, managed care, or in a medical or behavioral health setting

Preferred License, Certification, Association:

• Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Certified in Health Education and Promotion (CHEP), Licensed Professional Counselor (LPC/LPCC), Respiratory Therapist, or Licensed Marriage and Family Therapist (LMFT)

Knowledge/Skills/Abilities:

• Conduct clinical assessments to determine eligibility for case management based on clinical judgment, health changes, or assessment triggers
• Develop and implement a case management plan in collaboration with the member, caregiver, physician, and healthcare professionals to address member needs and goals
• Perform telephonic, face-to-face, or home visits as required
• Monitor care plans to evaluate effectiveness, document interventions, track goal achievement, and suggest adjustments
• Maintain a caseload for regular outreach and case management
• Integrate behavioral health and long-term services to enhance continuity of care for members
• Facilitate interdisciplinary care team meetings and encourage collaboration within the team
• Use motivational interviewing and clinical guideposts to educate, support, and motivate change in members
• Address barriers to care by coordinating with members and providing resources to meet their needs
• Collaborate with RN case managers and supervisors as necessary

Travel Requirements:

• Local Travel up to 40% may be required, depending on the complexity level of assigned members and state-specific regulations.