You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Develops, assesses, plans, implements, and coordinates complex care management activities based on member needs primarily focused on behavioral health needs (including behavioral health, and social needs) to provide quality, cost-effective healthcare outcomes. Develops a personalized care plan/service plan as appropriate/required and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.
- Develops and continuously assesses ongoing care plans/service plans of the members with high level acuity via phone and works to identify providers, specialists, and community resources needed for care including mental health and social determinant needs
- Coordinates and manages, as appropriate, between the member and/or family and the care provider team to ensure identified services are accessible to members
- Maintains a caseload with higher volume of complex/specialty cases
- Monitors member status and outcomes for changes in treatment side effects, complications and clinical symptoms and revises care plan/service plan based on member needs and issues identified including mental health and substance use disorders
- Identifies problems/barriers for care coordination and appropriate care management interventions for advanced and complex cases including mental health and substance use disorders
- Reviews member data to identify health risks and/or care gaps, and improve operating performance and quality care to address member's needs/issues and provides recommendations in accordance with state and federal regulations
- Reviews referrals information and intake assessments to develop appropriate care plan for complex/specialty cases
- Collaborates with healthcare providers and partners (including behavioral) as appropriate to facilitate care coordination and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
- Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
- Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs
- Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
- May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
- Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
- Engages and assists new hire/preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
- Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
- Performs other duties as assigned
- Complies with all policies and standards Education/Experience: Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 4 - 6 years of related experience. License/Certification:
- Licensed Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMSW, LMFT, LMHC, LPC and RN with BH experience required
- For Washington plan only: Licensed Behavioral Health Professional or RN (State Licensure and/or Compact State Licensure) based on state contract requirements e.g., LCSW, LMSW, LMFT, LMHC, LPC and RN with BH experience.Pay Range: $72,400.00 - $130,100.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act