Care Manager

As a Care Manager, you will coordinate person-centered care for members with complex medical, behavioral health, functional, and social needs. You will complete assessments, develop and monitor care plans, coordinate healthcare and community-based services, address barriers, and support successful transitions to and stability in community settings. Working with members, families, providers, and community partners, the you will promote member choice, independence, dignity, and progress toward individual goals. The Illinois Tailored Care Management Program helps individuals with complex health and social needs transition from nursing facilities and Specialized Mental Health Rehabilitation Facilities (SMHRFs) to community-based living. Through person-centered care management and coordinated support services, the program empowers members to live more independently and thrive in their communities.

Complete comprehensive assessments of members’ medical, behavioral health, functional, medication, housing, transportation, social support, and other health-related social needs Develop and update individualized care plans based on member goals, preferences, strengths, risks, and identified needs Engage members and authorized representatives in care planning, education, and informed decision-making Coordinate healthcare, behavioral health, housing, transportation, benefits, social services, and community-based supports with providers and partners Plan and support transitions from institutional, inpatient, residential, or other higher-acuity settings to community-based care, including appointments, medications, equipment, and services Identify and resolve transition barriers, coordinate continuity of care, and provide follow-up to support community stability Maintain regular member contact, provide education on available services and benefits, and monitor progress toward care plan goals Document assessments, care plans, contacts, transition activities, barriers, interventions, and outcomes accurately and on time while meeting caseload expectations Escalate unresolved clinical, behavioral health, housing, transportation, safety, or access barriers and participate in interdisciplinary case reviews and transition meetings Meet quality, documentation, productivity, member engagement, and transition performance standards Complete required training, competency validation, quality improvement, and corrective action activities Maintain required licensure, credentials, and knowledge, and perform other duties as assigned.

Registered nurse (RN), occupational therapist (OT), or clinician with a master’s degree in counseling, social work, psychology, or a closely related field Active Illinois professional license in good standing Valid driver’s license and ability to travel locally up to 100%

Experience in human services and working with individuals with serious mental illness and complex medical needs Qualified Intellectual Disability Professional (QIDP) experience Bilingual proficiency in English and Spanish