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Centene

Runs government-backed health insurance plans

Care Manager

Mental & Behavioral HealthPosted on Nov 9
Full-timeOregon, USA$56.2k - $101k /yr

About the Job

Requirements

  • A Master's degree in Behavioral Health or Social Work, or a degree from an accredited School of Nursing.
  • Two to four years of related experience.
  • A Licensed Master's Behavioral Health Professional credential (for example, LCSW, LMSW, LMFT, LMHC, or LPC), or an RN credential based on state contract requirements, with behavioral health experience.

Responsibilities

  • Evaluate member needs by phone or in-home visits, identify available resources, and recommend or facilitate a care plan or service plan for the best outcome, including behavioral health and social determinant needs.
  • Conduct telephonic, digital, home, or other site-visit outreach to assess member needs and collaborate with resources.
  • Develop ongoing care plans for members with high acuity and identify providers, specialists, and community resources for care, including mental health and substance use disorders.
  • Coordinate among members and their families or caregivers, community resources, and the care provider team to ensure identified services are accessible.
  • Monitor care plans, service plans, member status, and outcomes for changes in treatment side effects, complications, or clinical symptoms, and recommend care plan changes based on identified member needs.
  • Facilitate care coordination and collaborate with providers or specialists to ensure members have timely access to needed care or services.
  • Collect, document, and maintain member information and care management activities to ensure compliance with state, federal, and third-party payer regulations.
  • Educate members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, including behavioral health and social determinant needs.
  • Provide leadership with feedback on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
  • Perform other duties as assigned.
  • Comply with all policies and standards.

Desired Qualifications

  • Case management and behavioral health experience are strongly preferred.

About the Company

Centene

Runs government-backed health insurance plans

Centene runs government-backed health insurance plans in the United States, with Medicaid as its largest business alongside Medicare and Affordable Care Act Marketplace coverage. It is one of the largest Medicaid insurers in the country and also runs plans for people eligible for both Medicare and Medicaid, long-term care and children in foster care. States and the federal government pay Centene a set amount per member to manage care, and individuals buy its Ambetter Marketplace plans, often with federal subsidies. Centene contracts with local doctors, hospitals and pharmacies and keeps the difference between premiums and the cost of care. The company was founded in 1984 in Milwaukee and is headquartered in Clayton, Missouri.

Company size
10,001+
Company stage
IPO
Headquarters
Clayton, MO
Founded
1984

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