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Behavioral Health Clinical Care Mgr

Envolve Irving, Texas

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.

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What does it take?

What are the qualities that will help you achieve success in this role at Centene?

Success Profile

  • Detail-oriented
  • Trustworthy
  • Personable
  • Quick-thinking
  • Multi-tasker
  • Good listener

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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.

Care Manager

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.

Referral Specialist

You’ll use our data systems to directly assist providers, requesting services and treatments for our members.

Medical Director

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.

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Responsibilities

Job ID 1164530

Category Clinical & Nursing
Schedule Full-time
Description:
Position Purpose: Handle inbound and outbound member and provider calls on a clinical phone queue. Ensure members receive behavioral health services appropriate to clinical need. Triage crisis calls to assist with stabilization and access to emergency evaluation. Coordinate services with other departments, such as medical case/care management. Perform utilization management functions, including authorization determinations and care shaping.

Handle member calls, performing activities such as telephonic clinical assessment, determining appropriate level of care and services and answering benefit questions.
Perform utilization review functions with behavioral health providers, including care shaping and authorization determinations.
Responsible for utilization management activities with providers and/or member calls, depending on team.
Triage crisis calls, providing in-the-moment support and assisting with access to emergency services.
Use established protocols, as well as clinical judgment, to evaluate and problem solve during interactions with members and providers.
Document all calls and activities within a data management system and access multiple databases for benefit and workflow information.
Enhance clinical knowledge and skills by actively participating in all assigned training and staff meetings
Qualifications:


Education/Experience: Master’s degree in behavioral health and 3+ years of behavioral health experience (at least 2 years must be post-Master's degree). Prior managed care experience preferred. Prior experience with multiple system applications and electronic data entry, including call center and/or health care databases preferred.

License/Certification: Unrestricted license as Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT) or Licensed Psychologist (PhD).

 

This position is a full time after-hours response position; hours are 4PM - 12:30AM and includes working weekends and holidays.   



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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Quote

“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

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Our Awards

Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.

Honored to be Honored

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Our Hiring Process

Learn more about our hiring process and discover other helpful information for applicants.

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“Flexibility is key. Centene is a company of change.”

Ashley Collier

Started as a Referral Specialist, now a Project Manager IV

See Ashley's career path

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