Behavioral Care Mgr
Carolina Complete Health Durham, North Carolina
As a member of the Centene Medical Management/Health Services team, you’ll help innovate and execute strategies that redefine the industry standard for improving the lives and health of people. We’re a team of skilled physicians, nurses, pharmacists, social workers and health service experts who use our advanced clinical analytics to implement award winning programs, develop care, deliver partnerships, and work directly with our members to achieve outcomes that set us apart as industry leaders. Together, we’re transforming the health of communities, one person at a time.
What does it take?
What are the qualities that will help you achieve success in this role at Centene?
- Good listener
Our Medical Roles
Clinical & Nursing Opportunities at Centene
Our Clinical team is at the forefront of our purpose-driven work. Learn more about how you can help transform the health of our communities, one person at a time.
Overall Medical Management
A member of the Centene Medical Management team, we innovate and execute strategies that redefine the industry standard for improving the lives and health of people.
Concurrent Review Nurse
To ensure our members get the best quality of care, you’ll assess acute member health conditions, treatment and intervention options, and match them with providers, community and health plan resources.
Prior Authorization Nurse
You’ll ensure our members get the best quality services, assistive devices, and equipment to promote optimal health and independence in the community and help promote health and independence.
Working directly with members, interdisciplinary care team, providers and data analytics, you’ll identify member health risks and conditions and intervention and service options.
LTSS Program Specialist/Program Specialist Field Based
Working directly with our most vulnerable members, you’ll identify individual member health risks and opportunities to enhance independence, quality of life and community engagement.
You’ll use our data systems to directly assist providers, requesting services and treatments for our members.
To help support the individual needs of members and develop programs that address issues, you’ll review population health data, help design clinical programs, and develop care delivery partnerships.
Category Clinical & Nursing
Position Purpose: Authorize and/or review utilization of mental health and substance abuse services provided in inpatient and intermediate care settings. Assure appropriate levels of care and medical necessity in a manner that supports the recovery process
Identify placement settings that offer the lowest level of restriction and greatest level of autonomy for the members based upon medical necessity
Monitor quality of care and collect and analyze utilization data
Serve as a resource and liaison between the health plan, behavioral providers, facilities, member and families
Provide and/or review member intakes and initial evaluations
Comply with performance measures in regards to denials, higher level of care admission certifications and concurrent review timeliness
Develop and maintain collaborative relationships with providers and educate on levels of care
Interact with physicians, social workers, providers, case managers, and family members to develop discharge plans and oversee their implementation
Education/Experience: Bachelor’s degree in related field or equivalent experience. Master’s degree preferred. 3+ years of utilization management or clinical supervision experience in a behavioral health setting. Proficient in Microsoft Applications. Previous experience documenting in Case Management or Utilization Management systems.
Licenses/Certifications: Must have a license to practice independently, and/or have obtained the state required licensure as outlined by the specific state. This includes but is not limited to licenses such as LPC, LCSW, LMFT, LMHC, LIMHP, and RN.
For North Carolina only: Behavioral Health (BH) Managers and Full-Time BH Staff: These individuals shall be responsible for integrating into the clinical and care management teams to ensure Member’s behavioral health needs are fully integrated into the service delivery system.
• Must reside in North Carolina
• Experience working in behavioral health managed care and clinical setting
• Licensed behavioral health professional practicing within their scope
For North Carolina: RN, LCSW/LISW or LPC highly preferred
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.
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“Centene is an exciting company to work for, the pace at which we’re growing allows numerous advancement opportunities. Also, we foster an environment that supports and offers numerous leadership growth opportunities.”- Esmeralda Baig, SVP Operations, Complex Care Products
“I assisted with one of the Provider fairs in the community. Seeing how much we care for our community and our patients was very eye opening.”- Julie Boulch, Director, Business Implementation Health Plan Initiatives
Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.Honored to be Honored
Our Hiring Process
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“Flexibility is key. Centene is a company of change.”
Started as a Referral Specialist, now a Project Manager IVSee Ashley's career path
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