LPC, LCSW, or Psych RN - LTSS Service Care Manager

Centene Corporation•Waco, TX

1d•Hybrid

About The Position

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 visits.

Requirements

Requires a Master's degree in Mental Health or Social Work or Graduate from an Accredited School of Nursing and 2 – 4 years of related experience.
Licensed Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LPC, or RN with Behavioral Health experience is required.
Reliable transportation is required.

Nice To Haves

Clinical LPC, LCSW, or Psych 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 LPC, LCSW, Psych 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.
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.

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.