Care Manager (Behavioral Health)

Centene Corporation

1d•Remote

About The Position

Centene is transforming the health of its communities, one person at a time. This role is remote but requires the candidate to reside in Missouri and will work with foster care parents of children aged birth to 12. The position involves developing, assessing, and facilitating complex care management activities for members with mental and behavioral health needs to achieve high-quality, cost-effective healthcare outcomes. This includes creating personalized care plans and providing education to members and their families regarding mental health and substance use disorders. The role may involve telephonic, digital, home, or other site visits to assess member needs and connect them with available resources, recommending and facilitating care or service plans for optimal outcomes. The Care Manager will develop ongoing care plans for members with high acuity, identify necessary providers, specialists, and community resources, and coordinate care between members, families/caregivers, community resources, and the care provider team. They will monitor care plans and member status, providing recommendations for adjustments based on identified needs, and ensure timely access to care. Responsibilities also include collecting and maintaining member information for regulatory compliance, educating members and families on procedures, treatment options, and benefits, and providing feedback to leadership on improving care delivery. The role requires adherence to all company policies and standards.

Requirements

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

Responsibilities

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.