Care Manager - Mental Health, Psychiatric RN

Centene Corporation•McAllen, TX

9d•Hybrid

About The Position

Centene is seeking a Care Manager - Mental Health, Psychiatric RN to provide case management and service coordination to members living with mental illness and/or substance abuse disorders. This role focuses on developing, assessing, and coordinating holistic care management activities to achieve quality, cost-effective healthcare outcomes. The position involves evaluating member service needs, developing care plans, and educating members and their families on available services and benefits. The role requires frequent home and/or other site visits to assess member needs and collaborate with resources. The Care Manager will also provide subject matter expertise on mental and behavioral health activities, coordinate community resources, and ensure appropriate referrals and accessible services. Accurate documentation in the electronic care management system and compliance with clinical and regulatory guidelines are essential. The role also involves providing feedback to leadership on improving care quality and service delivery.

Requirements

Graduate from an Accredited School of Nursing
2 – 4 years of related behavioral health/psychiatric experience.
RN - Registered Nurse - State Licensure and/or Compact State Licensure required or NP - Nurse Practitioner - Current State's Nurse Licensure required
Critical thinking skills and ability to use nursing judgement to assess member’s health risks to ensure member safety
Strong clinical documentation and time management skills
Flexibility, resilience, and excellent interpersonal communication skills for member advocacy
Reliable transportation is required

Nice To Haves

Clinical RN with 3+ years of psychological admissions/intakes, medication management for mental health/ physical health conditions, care coordination, and discharge planning with adult (ages:18 - 65)
3+ years of clinical RN experience supporting members with primarily mental/behavioral health needs, such as those with (or a history of) major depression, bipolar disorders, schizophrenia, borderline personality disorder, post-traumatic stress disorder, substance use disorder, self-injurious behavior, psychiatric inpatient admissions, etc.
Direct work experience coordinating and managing healthcare/behavioral health services and personal assistance/social services, and providing patient advocacy and education to Medicaid members.
Experience in FIELD-BASED roles or work in-patient behavioral health hospital, community health, home health, outpatient mental health, substance abuse/ detox recovery treatment, or state social services settings (MHAs, LIDDA) is preferred.
Current or previous government-sponsored healthcare experience preferred.

Responsibilities

Develops, assesses and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes.
Evaluates member service needs and develops or contributes to development of care plans/service plans, and educates members, their families and caregivers on services and benefits available to meet member needs.
Evaluates the needs of the most complex and high-risk members with mental/behavioral health needs, and recommends a plan of care for the best outcome.
Acts as liaison and member advocate between the member/family, physician, and facilities/agencies.
Supports members with primarily mental/behavioral health needs, such as those with (or a history of) major depression, bipolar disorders, schizophrenia, borderline personality disorder, post-traumatic stress disorder, substance use disorder, self-injurious behavior, psychiatric inpatient admissions, etc.
Performs frequent home and/or other site visits (once a month or more), such as to assess member needs and collaborate with resources, as required.
Provides and/or facilitates education to long-term care members and their families/caregivers on topics such as preventive care, procedures, healthcare provider instructions, treatment options, referrals, prescribed medication treatment regimens, and healthcare benefits.
Provides subject matter expertise and operational support for relevant mental and behavioral health-focused activities, such as the handling of crisis calls, mental health first aid training, field safety and de-escalation practices, psychotropic and other medication monitoring, etc.
Educates on and coordinates community resources, to include medical, behavioral and social services.
Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living).
Ensures appropriate referrals based on individual member needs and supports the identification of providers, specialists, and community resources.
Ensures identified services are accessible to members.
Maintains accurate documentation and supports the integrity of care management activities in the electronic care management system.
Works to ensure compliance with clinical guidelines as well as current state and federal guidelines.
Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.
Performs other duties as assigned.
Complies with all policies and standards.
Travel is required for In-Person member assessments.