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.
This is a remote/work-from-home opportunity with member visits required for the position. Candidates must reside in Miami-Dade County to be considered for this role.
Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
- Develop, assess and adjust, as necessary, the care plan and promote desired outcome
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
- Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
- Provide patient and provider education
- Facilitate member access to community based services
- Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
Education/Experience: Bachelor’s degree in Social Work. 2+ years of social work experience in an acute care or community setting. Knowledge of government sponsored managed care programs preferred.
Licenses/Certifications: Current state’s LMSW or LCSW license.
For Sunshine Health (FL): An RN, LCSW, LMSW, LMHC or other Mental Health Professional license is required. Employees supporting Florida's Children’s Medical Services (CMS) must have one of the above professional licenses and 1. Minimum of two years of pediatric experience for Florida licensed registered nurses, or 2. Hold a Master’s degree in social work or related field and have one year of related professional pediatric care experience. May require up to 80% local travel.
Licensure requirement: Master’s degree in social work or related field, Florida LMSW or LMHC, and have one year of related professional pediatric care experience
Experience: 1 year (minimum) pediatric experience
Location: Candidates must reside in Miami-Dade County
Travel: 80% local travel
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
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.