Clinical Case Manager (Sign-on Bonus)

Activate Care•Las Vegas, NV

4d•Hybrid

About The Position

Activate Care is dedicated to improving health equity and outcomes nationwide through its Community Care Record platform, which facilitates care coordination for individuals with health-related social needs. Their Path Assist program utilizes tech-enabled community health workers (CHWs) for structured interventions aimed at boosting health confidence, self-efficacy, and reducing healthcare spending. The Clinical Case Manager is a senior clinical resource embedded within a CHW team, providing clinical oversight, case consultation, and direct assistance to CHWs serving Medicaid members. This role involves addressing complex and high-risk situations, conducting assessments, supporting care planning, and acting as an escalation point for behavioral health, crisis, or safety concerns. The objective is to enhance the clinical quality and safety of the team's work while developing the CHWs' skills and confidence. The company is open to licensed professionals such as RNs, LPNs, LCSWs, and LMHCs, as well as experienced case managers from hospital, discharge planning, and managed care backgrounds. Specific clinical activities are performed within each individual's scope of practice.

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).
Prior case management, hospital, discharge planning, or care coordination experience strongly preferred.
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

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