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Senior Care Manager EAP & Behavioral Health

Buckeye Community Health Plan Ohio, Columbus, Ohio, Fairlawn, Ohio

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 1148855
Additional Locations Columbus,Ohio,US;Fairlawn,Ohio,US
Category Clinical & Nursing
Schedule Full-time
Description:

Position Purpose: The Sr. Care Manager EAP & Behavioral Health’s workload is focused on care that is either facility based or outpatient based and is primarily responsible for managing care managers’ workload and authorizing care.


The Sr. Care Manager receives calls for care that involves some degree of clinical or other risk (e.g. police, emergency room needs, facility nursing staff, etc.). They informally train, post train, re-train, onboard, and mentor Care Managers. Sr. Care Managers act in a lead capacity. They assign cases, monitor workload and redirect as appropriate, monitor phone communication (e.g. care manager calls), assist supervisor on audits of care managers’ work, and report performance metrics to the supervisor.


On a facility focused team, the Sr. Care Managers receive calls from the internal pre-authorization or concurrent review departments. They can authorize care based on pre-existing criteria and follow it through discharge, step down, and out-patient care. On the outpatient team, Sr. Care Managers receive escalated member calls from care managers (care managers receive escalated calls from customer service). The calls are escalated when there are any emergent risks (emergency room, police to be called, etc.) or concerning issues that require problem solving (e.g., grievances, appeals).


All Sr. Care Managers review provider and benefit limits (e.g. Medicare), conduct risk assessments, and provide problem solving. With a new and changed member population, they also help assist members in accessing the database, problem solving, etc.

  • Evaluates high risk cases, complexity of services, health care costs, non-compliance issues, and other triggers as per policy. Issues pre-authorizations. Conducts concurrent reviews. Reviews Psychological/Neuropsychological Testing Requests.
  • For outpatient Sr. Care Manager only: Takes escalated calls from Care Managers (assessing needs and risk of the caller, linking the caller to the appropriate resources, following up with callers, filing APS/CPS reports when necessary, completing county referral forms for MediCal members, processing SCA requests, completing exempt and formal grievances, filing PAI's and PQI's, etc.).Identifies appropriate members for care coordination services. The Sr. Care Manager provides referrals to outpatient providers and facilities per member requests. They coordinate care between medical and behavioral health vendors, as well as different care levels of behavioral health care. They follow up to ensure community based referrals are being utilized. Analyzes complex cases; screens members for care coordination, and makes innovative use of available resources.
  • Reviews, coordinates, and makes recommendations with Medical Director, clinical manager, and Care Managers when appropriate.
  • Assigns cases, monitors workload and redirects as appropriate, monitors phone communications (e.g. care mangers’ calls), assists supervisor on audits of care managers’ work, and reports performance metrics to the supervisor. Enters clinical notes and completes appropriate authorizations based on medical necessity.
  • Manages cases to ensure that the beneficiaries’ clinical needs are met at the most cost effective and clinically appropriate level.
  • Communicates with both internal and external customers. Educates providers, members and beneficiaries regarding benefits. Monitors benefit utilizations and educates members regarding Medicare.
  • Identifies Potential Quality Indicators using criteria established by the QM department.
  • Performs other duties as required.
  • Qualifications:
    Education/Experience: Social Work license (LCSW, MSW) Or Licensed Professional Counselor (LPC) Or Licensed Marriage and Family Therapist (LMFT) or PhD in related field. 2+ years of care/case management/related experience or 2+ years of psychiatric experience in an acute behavioral health or an outpatient private practice setting.

    License/Certification:Current, valid, unrestricted LCSW, MSW, LPC, LMFT, RN or licensed psychologist (PhD) required

    For Buckeye Health Plan: valid, unrestricted LISW, LSW, LCPC or RN is 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

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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

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