Clinical Case Manager (Sign-on Bonus)

Activate Care•Carson City, NV

5d•Hybrid

About The Position

At Activate Care, we’re on a mission to improve health equity and drive improved health outcomes across the country. Our Community Care Record platform enables healthcare and community organizations to coordinate care for populations challenged with health-related social needs. Path Assist is our tech-enabled community health worker program for HRSN utilizing an evidence-based, structured intervention. Our goal is simple: increase health confidence, improve self-efficacy, and reduce inappropriate healthcare spending.

Requirements

Active, unrestricted Nevada license in one of the following: Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), or Licensed Mental Health Counselor (LMHC).
Degree appropriate to your licensure (for example, ASN or BSN for nursing, MSW for LCSW, master's in counseling for LMHC).
3+ years of post-licensure clinical or case management experience, including assessment and, where applicable to your scope, crisis intervention.
Experience working with Nevada Medicaid, underserved, or community-based populations.
Ability to work effectively alongside CHWs and interdisciplinary teams as a non-supervisory clinical resource.
Comfort with community/field-based work and telehealth; valid driver's license and reliable transportation if field travel is required.

Nice To Haves

Prior case management, hospital, discharge planning, or care coordination experience strongly preferred.
Case Management Certification (for example, CCM) is preferred.
Demonstrated experience with Medicaid documentation, billing workflows, or CPT/HCPCS coding within an integrated care or care management setting is a plus.
Strong knowledge of social determinants of health and community resource navigation.
Managed care, care management, or integrated behavioral health experience preferred
Familiarity with local community resources and the regional behavioral health landscape.

Responsibilities

Serve as the embedded clinical resource for a team of CHWs
Provide real-time case consultation, clinical guidance, and side-by-side assistance to CHWs on complex member situations.
Own the daily clinical audit of the Transitions of Care (TOC) queue, utilizing health plan guidelines to appropriately triage complex Level 2 cases and route clean Level 1 referrals to the CHW team.
Identify members whose needs exceed the CHW scope and step in directly or coordinate the appropriate clinical hand-off.
Lead and represent the organization in monthly joint Level 1 and Level 2 case conferences with health plan clinical leadership.
Coach and mentor CHWs to strengthen engagement skills, recognition of behavioral health and risk indicators, and appropriate escalation.
Oversee the end-to-end Medicaid claims cycle for the clinical team, including pre-submission documentation reviews, code utilization tracking, and denial management.
Identify and execute direct-billing opportunities for licensed behavioral health interventions and assessments allowable under Nevada Medicaid.
Help develop and reinforce team workflows, clinical protocols, and best practices in partnership with leadership.
Conduct biopsychosocial and behavioral health assessments to identify member needs, strengths, and risks.
Provide brief, evidence-based clinical intervention (such as motivational interviewing and solution-focused techniques) and warm hand-offs to ongoing behavioral health treatment.
Contribute clinical expertise to individualized care plans as part of the interdisciplinary care team (ICT).
Apply trauma-informed and culturally responsive practice across a diverse, predominantly Medicaid population.
Serve as the team's escalation point for members presenting with behavioral health, safety, or crisis concerns.
Conduct risk assessment and coordinate appropriate crisis response, follow-up, and linkage to emergency or stabilization services.
Support CHWs through difficult situations in the field and debrief afterward.
Partner with CHWs to connect members to behavioral health services, community resources, and supports addressing social determinants of health, including housing, food, transportation, employment, and benefits.
Build and maintain relationships with community-based organizations and behavioral health providers across the assigned territory.
Coordinate with PCPs, care managers, and health-plan partners to close gaps in care.
Maintain timely, accurate clinical documentation in the care management platform.
Ensure work meets Medicaid, state, NCQA, and organizational clinical and privacy (HIPAA) standards.
Contribute to quality initiatives and outcome tracking for the team.
Other duties as assigned