Children's Behavioral Health Case Manager
Fidelis Care New York, New York
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: Works with youth members, parents/legal guardians and providers to achieve better behavioral, developmental and physical health appointment and care compliance to prevent the incurrence of high cost or poor clinical outcomes; works to target the reduction of case complications through identification of high risk triggers; coordinates care from a family-driven, youth guided approach, maintaining clear communication channels with the member and their family, providers, Health Homes and plan staff.
Adhere to clinical standards of care for children including but not limited to SED, Developmentally Disabled, Medically Fragile and foster care populations, through collaboration with providers; practice and adhere to departmental and State guidelines for HCBS and State Plan Services; monitor for appropriate outcomes.
Provide Utilization Management and Care Management support for identified member groups and specific services.
Communicate with youth members, parent/legal guardian or other identified family, and medical and community based service personnel in a timely fashion, as necessary, to facilitate a mutually desired outcome.
Work collaboratively with medical utilization management and care management teams in order to best support members holistic needs.
Collaborate with the Physician Advisor; assess appropriateness and effectiveness of recommended treatment and care.
Create and manage electronic member files to document member data including treatments and progress.
Attend educational workshops; review professional publications to stay abreast of current trends; establish personal networks and participate in professional societies to maintain professional and technical knowledge.
Education/Experience: Master’s degree or equivalent required; Bachelor’s degree required with RN license. One to three years clinical experience with children, families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations is required; assessing treatment needs and making recommendations that impact desired outcomes while maintaining high quality of care. Three to five years related experience preferred. Business Analysis Knowledge: Skilled to work in a fast paced environment. Must have strong analytical and problem solving skills. Computer Systems: Possesses basic skills and comfort with navigating multiple computer based programs, applications and databases such as Microsoft Word, Excel, electronic health records and internet navigation. Customer Service: Skilled to communicate with all levels of management, internal and external customers. Ability to work well as a member of a team or alone. Effective Business Communication: Skilled in communicating with technical and business constituencies in writing effective business specifications and requirements. Proficiency in Microsoft Office: Excel, Word, Access; Lotus Notes; Internet.
License/Certification: NYS LMSW, LCSW, LMHC or RN License required
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
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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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