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.
Position Purpose: Manages the care management team and the care coordination of behavioral health members to develop and assess high quality, cost-effective healthcare outcomes related to mental and behavioral health needs. Manages escalations and care management issues related to members or providers.
- Oversees and reviews care management required documentation to maintain compliance with federal and state regulations and contractual agreements.
- Develops, implements, and oversees care management policies and procedures within the care management team based on regulatory requirements and industry standards.
- Directs the daily activities of care management staff including reviewing and approving the caseloads of care management staff based on state requirements, care management staff experience, and member needs.
- Manages escalated and complex care cases, and provides guidance to team members to address member concerns related to mental and behavioral health members.
- Manages resolutions of complaints and assists in audits and evaluations related to care programs.
- Develops, implements, and oversees care management programs to facilitate the use of appropriate services and resources.
- Sets goals and objectives for care management team to achieve cost-effective healthcare results.
- Works with care management senior management to provide updates and insights on care management team goals.
- Provides feedback to care management team to improve member and provider experience and high-quality care.
- Educates and provides resources for care management team on key initiatives and member outreach to facilitate ongoing communication between care management team, members, and providers.
- Assists care management senior leadership with onboarding, hiring, and training new care management employees, recent promotes, and transfers within the department.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Requires a Master's degree or Graduate from an Accredited School of Nursing and 5+ years of related experience.
License/Certification:
- Licensed Clinical Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMSW, LMFT, LMHC, and RN with BH experience.
- Or Associated license working towards full licensure required.
Pay Range: $98,900.00 - $183,100.00 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.
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