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.
Must reside in the State of Hawaii. Quarterly in-person meetings & meetings with providers as necessary on Oahu.
Position Purpose: Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Acts as provider liaison to oversee the Community Based Case Management (CBCM) Agencies who deliver and coordinate the behavioral services of the CCS contract. Monitors CCS contract compliance of the CBCM Agencies by collecting clinical data and maintaining accurate records for tracking and metric purposes. Candidate Education: * Required A Master's Degree in Social Work, Psychology, Counseling, Rehabilitation, or other relevant field that provides a foundation to receive a license as required of the position 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 Other Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
- Preferred Other Experience in a managed care environment Licenses and Certifications:A license in one of the following is required: Required Other 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)
- Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability.
- Acts as provider liaison to oversee the Community Based Case Management (CBCM) Agencies who deliver and coordinate the behavioral services of the CCS contract.
- Identification and tracking of all assigned members of assigned CBCM agencies.
- Audits member records for compliance of CCS contract.
- Collects clinical data and maintains accurate records for tracking and metric purposes.
- Oversees CCS contract compliance of the CBCM agencies (i.e. Behavioral Health Assessment (BHA)/Individualized Treatment Plan (ITP) received within specified timeframes, quarterly BHS reports, post hospitalization follow up, etc.).
- Maintains ongoing contact with assigned CBCM agencies. Participates in agency educational meetings and agency visits.
- Facilitates enrollment and eligibility changes.
- Performs other duties as assigned. Additional Responsibilities: * Notifies CBCM Agency when a member is admitted for a Behavioral Health Inpatient Hospitalization.
- Reviews authorization requests for CCS program benefits.
- Serves as Officer of the Day (OOD) to address calls from customer service and internal ‘Ohana staff.
- Processes Adverse Events.
- Coordinates with member’s QUEST Integration Health Plan Service Coordinator for continuity of care.
- Holds Interdisciplinary Team (IDT) Meetings for complex, high-risk, high-utilizing members and participates in departmental clinical rounds.
Required Licensed Clinical Mental Health Counselor (LCMHC): Required Licensed Psychologist
Required Licensed Clinical Marriage & Family Therapist (LCMFT):
Required Licensed Clinical Psychologist (LCP): Required Acute Care Nurse Practitioner (APRN) (ACNP-BC)
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.