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Care Manager

Centene Corporation • Remote • Posted 1 day ago

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Remote • Full-time • $54,000-$97,100/yr • Mid Level

Job Highlights

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The Care Manager at Centene Corporation is responsible for developing, assessing, and facilitating complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes. This includes personalized care plans and education for members and their families related to mental health and substance use disorder. The role involves evaluating member needs, recommending and facilitating care plans, coordinating between members, families/caregivers, community resources, and care providers, and ensuring compliance with regulators.

Responsibilities

  • Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs
  • May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources
  • Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders
  • Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members
  • Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs
  • Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services
  • Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
  • Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs
  • Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
  • Performs other duties as assigned
  • Complies with all policies and standards

Qualifications

Required

  • Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing
  • 2 - 4 years of related experience
  • Licensed Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMSW, LMFT, LMHC, LPC and RN with BH experience required
  • Must reside in the state of Florida for Sunshine Health Plan

About Centene Corporation

Centene Corporation is a leading healthcare enterprise in the United States, specializing in managed healthcare products and services primarily through Medicaid, Medicare, and commercial products. They offer healthcare coverage through managed care plans that include medical, behavioral, and specialty services, aiming to improve health outcomes for underserved populations. Operating on a global scale, Centene has a significant presence in over 30 states and continues to grow through strategic expansions and partnerships, such as acquiring WellCare Health Plans in 2020.

Full Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

This is a remote/work from home role however; qualified applicants **_must_** reside in the state of Florida

**Position Purpose:** Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder.

+ Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs

+ May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources

+ Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders

+ Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members

+ Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs

+ Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services

+ Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators

+ Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs

+ Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner

+ Performs other duties as assigned

+ Complies with all policies and standards

**Education/Experience:** Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2 - 4 years of related experience.

**License/Certification:**

Licensed Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMSW, LMFT, LMHC, LPC and RN with BH experience required

**Sunshine Health Plan** : Must reside in the state of Florida. Licensed Behavioral Health Professional e.g., LCSW, LMSW, LMFT, LMHC required.

Pay Range: $54,000.00 - $97,100.00 per year

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act