Description
Position Purpose:
Perform duties related to the day-to-day operations of the Service Management functions for Foster Care members to achieve the highest possible levels of functioning and wellness by ensuring consistent, timely access to medically necessary behavioral health services. Monitor quality of care, assist with discharge planning.
Key Details: Centene is seeking a Behavioral Health Service Manager to support our Medicaid business as part of the Behavioral Health Medication Monitoring (BHMM) team operating across 12 markets. The ideal candidate will bring a strong behavioral health and clinical background, including experience with case management or utilization management, high-volume clinical reviews, medication monitoring, and medication management. This fast-paced role requires excellent organization, sound clinical judgment, and the ability to manage competing priorities while ensuring timely and accurate caseload management decisions.
Work with Foster Care Members, Medical Consenters, Department of Family and Protective Services (DFPS) staff and providers to meet the behavioral healthcare needs of each foster care member’s condition.
Identify foster care members who may benefit from service management, conduct an assessment and develop, implement and monitor a healthcare service plan.
Provide information to DFPS staff to facilitate development of the DFPS case plan.
Update database regularly with most recent Service Management Plan of Care.
Review information submitted by providers into the database to ensure material is appropriate and consistent with guidelines for data inclusion.
Encourage behavioral health providers to use evidence-based practices and confirm that behavioral health providers and PCP’s are sharing information as required.
Comply with established referral, pre-certification and authorization policies, procedures and processes by related medical management staff.
Maintain compliance with federal and state regulations and contractual agreements.
Coordinate service management functions with other departmental functions.
Monitor data to address trends or potential quality improvement opportunities.
Maintain HIPAA compliance.
Performs other duties as assigned
Complies with all policies and standards
Education/Experience:
Master's degree in Behavioral Health. 3+ years of case and/or utilization management experience. Experience in psychiatric health care settings, child behavioral health conditions and members with special needs. Working knowledge of utilization review procedures, and familiarity with mental health community resources. Thorough knowledge of a specialized or technical field such as clinical nursing, case and/or utilization management involving knowledge plus the application of basic theory. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Foster care experience strongly preferred.
License/Certification: Unrestricted license as a LCSW, LMFT, LMHC, LPC, PhD, PsyD or RN.
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
