Clinical Case Manager

About Activate Care

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.

This is a Hybrid role where applicants should reside within the state of Nevada to be strongly considered for this position.

The Clinical Case Manager is the senior clinical resource embedded within a team of Community Health Workers (CHWs) serving Medicaid members. While this role has no direct reports, the Clinical Case Manager is a leader on the team, providing clinical oversight, case consultation, and hands‑on assistance to CHWs as they engage members and address health‑related social needs. You bring licensed clinical judgment to the team's most complex and highest‑risk situations, conduct assessments within your scope of practice, support care planning within an interdisciplinary care team, and serve as the escalation point when members present with behavioral health, crisis, or safety concerns.

The goal is to elevate clinical quality and safety while building the CHWs’ confidence and skills.

We are open to a range of licensed backgrounds for this role, including RN, LPN, LCSW, and LMHC, as well as experienced case managers from hospital, discharge planning, and managed care settings. Specific clinical activities are performed within each person’s scope of practice.

• 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 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, recognize 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
• M…