Description
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
- Assesses, plans, implements, monitors and evaluates options and services to meet complex psychosocial health needs of inpatient and outpatient members.
- Manages a caseload in compliance with contractual obligations and WellCare standards.
- Conducts comprehensive member assessments through root cause analysis based on referred member's needs and benefit plan eligibility, and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs.
- Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability.
- Works towards achievement of optimal clinical and resource outcomes.
- Monitors and evaluates effectiveness of care plan and modifies plan as needed.
- Supports member access to appropriate quality and cost effective care.
- Coordinates with internal and external resources to meet identified needs of the member's care plan and collaborates with providers.
- Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
- Provides clinical consultation to physicians, professional staff and other teams members/supervisors to provide optimal quality patient care and effective operations.
- Interacts continuously with members, family, physician(s), and other resources to determine appropriate behavioral action needed to address medical needs.
- Reviews benefits options, researches community resources, trains/creates behavioral routines and enables members to be active participants in their own healthcare.
- Ensures members are engaging with their PCP to complete their care management treatment plan or preventive care services.
- Assists in obtaining benefits for members through community resources when benefits are exhausted or not available.
- Performs other duties as assigned.
- Additional Responsibilities: * In Hawaii, Registered Nurses may monitor the effect of medications, provide medication administration and education as needed under guidance of the Psychiatrist.
- The may provide education and clinical care for medical conditions and assists the Psychiatrist with member adherence to medications.
- Incumbents engaged in Florida's SMI program will manage members w
- Performs other duties as assigned
- Complies with all policies and standards
Candidate Experience: Required 2+ years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning
Required 1+ year of experience in current case management as a licensed professional
Required Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Preferred Experience in a managed care environment
Required 5+ years of experience in For KY SKY Program: candidates must have 5 years of behavioral health care experience
Licenses and Certifications: A license in one of the following is required:
A master's level independent or non-independent license is required OR an RN with a behavioral health background: Required Licensed Registered Nurse (RN)
Required Licensed Clinical Social Worker (LCSW)
Required Licensed Clinical Mental Health Counselor (LCMHC):
Required Licensed Clinical Professional Counselor (LCPC):
Required Licensed Clinical Marriage & Family Therapist (LCMFT):
Required Licensed Clinical Psychologist (LCP):
Required Licensed Master Social Work (LMSW):
Required Certified Social Worker (C-SW): Required Acute Care Nurse Practitioner (APRN) (ACNP-BC)
Required Other In New Jersey, one of the following is Required: Licensed Clinical Social Worker (LSW), Licensed Associate Counselor (LAC) or Registered Nurse (RN). Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC) Preferred.
FL License Requirement: RN, LCSW, LCMHC or other Mental Health Professional license
For Shared Services: Clinical licensure for multiple states is required
For Arizona Complete Health Plan: LCSW, LMFT, LPC, LISAC, or RN licensed in Arizona required. AZ Independent Behavioral Health License required.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
