Job 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.
Position Purpose: Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues. Assess members\' current functional level and, in collaboration with the member, develop and monitor the Case Management Care Plan, monitor quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the Integrated Case Management functions. Collaborate with both medical and behavioral providers to ensure optimal care for members.

• Work telephonically with patients identified as high risk, for both behavioral and physical health issues, and their providers to identify needs, set goals and implement action steps towards achieving goals.

• Empower patients to help them improve their quality of life and ensure an integrated approach to address complex issues.

• Understand and comply with NCQA guidelines and HEDIS measures.

• Comply with established referral, pre-certification and authorization policies, procedures and processes by related Medical Management staff.

• Additional responsibilities for LHCC (LA) for only DOJ positions:

• Each position will be the delegated agency\xe2\x80\x99s single point of contact to coordinate the overall CM activities provided to the target population

• Review and approve the initial and ongoing assessment and care plan to ensure requirements are met

• Coordinate service request/authorizations with UM and ensure agreement is aligned between the member, agency, and MCO

• Facilitate member linkages to MCO-based services and programs in collaboration w/ agency staff

• Assist members and/or agency staff w/ transportation to healthcare appointments

• Communicate status of member health indicators with agency staff that can contribute the successful community living of members

• Participate in weekly rounds w/ agency staff

• Other duties as assigned
• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Master\xe2\x80\x99s degree in behavioral health and an unrestricted license as a LCSW, LMFT or LPC, or a PhD, PsyD or RN. 3+ years of case and/or utilization management experience. Experience in psychiatric and medical health care settings. Working knowledge of mental health community resources.

License/Certification: Unrestricted license as a LCSW, LMHC, LMSW LMFT, LPC, PhD, PsyD or RN license in applicable state.

For New Hampshire Healthy Families: LICSW, LCMHC, LMFT, PsyD, MLADC, BCBA, or PhD license required. Candidates with active medical/social work licenses in good standing in other states than NH, must obtain the NH equivalent within 90 days of hire. Active driver\xe2\x80\x99s license in good standing preferred.

For Iowa Total Care: LISW, LMHC, LMFT or RN required

For the IDD populations:
Education/Experience: Master\xe2\x80\x99s degree in behavioral health and an unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD, RN, ABA, or BCBA. ABA or BCBA highly preferred. 3+ years of case and/or utilization management experience. Experience in psychiatric and medical health care settings. Working knowledge of mental health community resources.

License/Certification: Unrestricted license as a LCSW, LMHC, LMSW LMFT, LPC, PhD, PsyD, RN, ABA or BCBA license in applicable state. ABA or BCBA highly preferred.

For Sunflower Health Plan: Unrestricted license as a LMLP, LCSW, LMHC, LMSW LMFT, LPC, PhD, PsyD or RN license in applicable state. Valid Driver\xe2\x80\x99s license SED (Serious Emotional Disturbance) Waiver staff.

For Oklahoma Complete Health Only: Employees may be required to be on call. Employees will be required to make member visits.

For Shared Services: Clinical licensure for multiple states is required

For Illinois YouthCare plan only: Candidates are required to live within the specified region.

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.

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