Clinical Case Manager

Responsibilities

• Serve as the senior clinical resource and mentor for a team of Community Health Workers (CHWs).
• Provide real-time case consultation, clinical guidance, and assistance on complex member situations.
• Conduct biopsychosocial and behavioral health assessments to identify member needs and risks.
• Act as the escalation point for members presenting with behavioral health, safety, or crisis concerns.
• Oversee the Medicaid claims cycle for the clinical team, including documentation reviews and code utilization.
• Lead monthly case conferences with health plan clinical leadership.
• Coordinate with PCPs, care managers, and community providers to close gaps in care and address social determinants of health.
• Maintain accurate clinical documentation in compliance with Medicaid, state, and HIPAA standards.

Requirements

• Active, unrestricted Nevada license (RN, LPN, LCSW, or LMHC).
• Degree appropriate to your licensure.
• 3+ years of post-licensure clinical or case management experience.
• Experience working with Nevada Medicaid or underserved populations.
• Valid driver's license and reliable transportation for potential field travel.
• Must reside within the state of Nevada.

Preferred Qualifications

• Case Management Certification (e.g., CCM).
• Experience with Medicaid documentation, billing workflows, or CPT/HCPCS coding.
• Background in managed care, discharge planning, or integrated behavioral health.
• Familiarity with local community resources and the regional behavioral health landscape.

About the Company

Activate Care is on a mission to improve health equity and drive improved health outcomes. Our Community Care Record platform enables healthcare and community organizations to coordinate care for populations challenged with health-related social needs. Through our tech-enabled programs, we aim to increase health confidence, improve self-efficacy, and reduce inappropriate healthcare spending.