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: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination.

• Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development

• Monitor delivery of services and follow-up with members, caregivers, or provider s through in person visits and telephonic contact

• Authorize and coordinate referral for services

• Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care

• Assist in coordinating the development of informal or voluntary services to integrate into the member care plan

• Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services

• Assist member with filing and resolving complaints and appeals
• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Bachelor\xe2\x80\x99s degree or Registered Nurse License and 2+ years of care management experience, Licensed Practical Nurse and 4+ years of care management experience, or 6+ years of care management experience. Home health, discharge planning, or long term care experience preferred.

Licenses/Certifications: Valid driver\'s license. LPN or RN preferred.

For Kansas plan only: Have at least a bachelor\xe2\x80\x99s degree in social work, rehabilitation, nursing, psychology, special education, gerontology, or related health and human services area or be a Registered Nurse (RN). Full-time experience in the field may be substituted for the degree at a rate of 6 months of full-time experience for each missing semester of college. Experience with persons participating in HCBS waiver programs is preferred.

Pennsylvania requirements: Bachelor\'s degree or Registered Nurse License and 3+ years of experience in a social service or health care related setting, Licensed Practical Nurse and 5+ years of experience in a social service or health care related setting, or 7+ years of experience in a social service or health care related setting.

Licenses/Certifications: Valid driver\'s license. LPN, LCSW or RN preferred.

For Iowa plan only: Bachelor\'s degree with 30 semester hours or equivalent quarter hours in a human services field (including, but not limited to, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy) and at least one year of experience in the delivery of services to the population served in LTSS; or Iowa Registered Nurse License and at least 3 years of experience in the delivery of services to the population served in LTSS.

For North Carolina only:

• Must reside in North Carolina
• Must be licensed practitioners
• Must be supervised by an RN, LCSW, or psychologist with trauma-based experience and training.

Behavioral Health (BH) Managers and Full-Time BH Staff: These individuals shall be responsible for integrating into the clinical and care management teams to ensure Member\xe2\x80\x99s behavioral health needs are fully integrated into the service delivery system.

• Must reside in North Carolina
• Experience working in behavioral health managed care and clinical setting
• Licensed behavioral health professional practicing within their scope

For MHS Indiana plan only: Care Coordinators shall be located in Indiana and licensed as applicable in Indiana. Care Coordinators must be (1) registered nurses in good standing, (2) have a Master\xe2\x80\x99s degree in social work, (3) possess a bachelor\xe2\x80\x99s degree in social work, psychology, special education, or counseling and have at least a minimum of one (1) years of experience in providing case management services to individuals who are older adults and/or individuals with physical or developmental disabilities and/or individuals determined to have a serious mental illness (SMI), or (4) be a licensed practical nurse (LPN) with a minimum of three years of clinical experience with older adults. A portion of the Contractor\xe2\x80\x99s Care Coordinators shall have experience in behavioral health so that they may appropriately assist members with behavioral health conditions.

For Illinois Plan Only: In addition to the requirements above the employee working on

Persons with Brain Injury Waiver Care Coordinators must meet one (1) of the seven (7) following requirements:

• 1. Registered Nurse (RN) licensed in Illinois
• 2. Certified or Licensed social worker
• 3. Unlicensed social worker: minimum of bachelor\xe2\x80\x99s degree in social work, social sciences or counseling
• 4. Vocational specialist: certified Rehabilitation counselor or at least three (3) years\xe2\x80\x99 experience working with people with disabilities
• 5. Licensed Clinical Professional Counselor (LCPC)
• 6. Licensed Professional Counselor (LPC)
• 7. Certified Case Manager (CCM)

Persons with HIV/AIDS Waiver Care Coordinators must meet one (1) of the three (3) following requirements:

• 1. A Registered Nurse (RN) licensed in Illinois and a Bachelor\xe2\x80\x99s degree in nursing, social work, social

sciences or counseling or four (4) years of case management experience.

• 2. Social worker with a Bachelor\xe2\x80\x99s degree in either social work, social sciences or counseling

or a Masters of social work

• 3. Individual with a bachelor\xe2\x80\x99s degree in a human services field with a minimum of five (5) years of case management experience.

In addition, it is mandatory that the Care Coordinator for Enrollees within the Persons with HIV/AIDS Waiver have experience working with:

• Addictive and dysfunctional family systems
• Racial and ethnic minorities
• Homosexuals and bisexuals
• Persons with AIDS, and
• Substance abusers

Persons supporting Elderly Waiver:

• Care Coordinators must meet one (1) of the four (4) following requirements:

• 1. RN licensed in Illinois
• 2. Bachelor\xe2\x80\x99s degree in nursing, social sciences, social work, or related field
• 3. LPN with one (1) year experience in conducting comprehensive assessments and provision of formal service for the elderly
• 4. One (1) year of satisfactory program experience may replace one year of college education, at least four

(4) years of experience replacing baccalaureate degree

Persons supporting Disabilities Waiver:

• Care Coordinators must meet one (1) of the nine (9) following requirements:

• 1. Registered Nurse (RN)
• 2. Licensed Clinical Social Worker (LCSW)
• 3. Licensed Marriage and Family Therapist (LMFT)
• 4. Licensed Clinical Professional Counselor (LCPC)
• 5. Licensed Professional Counselor (LPC)
• 6. Doctorate in Philosophy (PhD)
• 7. Doctorate in Psychology (PsyD)
• 8. Bachelor or Master\xe2\x80\x99s Degree prepared in human services related field Bachelor\xe2\x80\x99s degree in Human Services related field defined as: (Child, Family and Community Services, Early Child Development, Guidance and Counseling, Home Economics- Child and Family Services, Human Development Counseling, Human Service Administration, Human Services, Master of Divinity, Pastoral Care, Pastoral Counseling, Psychiatric Nursing, Psychiatry, Psychology, Public Administration, Rehabilitation Counseling, Social Science, Social Services/Social Work or Sociology.
• 9. Licensed Practical Nurse (LPN)

Pay Range: $21.93 - $37.30 per hour

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 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.

Sunshine State Health Plan