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Centene

Runs government-backed health insurance plans

LPC – LCSW - Or Behavioral Health RN, Pediatrics

Mental & Behavioral HealthUpdated on Nov 6
Full-timeTexas, USA

About the Job

Requirements

  • A master's degree in Mental Health or Social Work, or graduation from an accredited school of nursing, is required.
  • A current LCSW, LPC, or RN license with direct behavioral health experience is required; LMSW and LPC-associate credentials do not qualify.
  • Two to four years of related behavioral health or mental health experience is required.
  • The licensed behavioral health professional or RN must meet state contract requirements.
  • Bilingual English and Spanish skills are preferred but not required.
  • Proficiency with Microsoft Office Suite and video-conferencing applications, including Outlook, Word, M365 Copilot, Excel, PowerPoint, OneNote, Teams, and Zoom, is required.
  • Ability to work independently with minimal supervision is required.
  • Local travel for member visits is required.
  • Flexibility to accommodate child and adolescent members' school schedules when needed is required.

Responsibilities

  • Develop, assess, and coordinate holistic care management activities, primarily supporting youth populations with significant mental and behavioral health needs, to enable quality, cost-effective healthcare outcomes.
  • Evaluate member service needs and develop or contribute to the development of care plans or service plans; educate members, their families, and caregivers about services and benefits available to meet member needs.
  • Travel within the service delivery areas for child and adolescent member visits to conduct SAI assessments, and provide care coordination from home.
  • Evaluate the needs of the most complex and high-risk members with mental and behavioral health needs, and recommend plans of care for the best outcomes.
  • Act as liaison and member advocate between members or families, physicians, and facilities or agencies.
  • Support members with mental and behavioral health needs, including those with a history of major depression, bipolar disorders, schizophrenia, borderline personality disorder, post-traumatic stress disorder, substance use disorder, self-injurious behavior, or psychiatric inpatient admissions.
  • Conduct frequent home or other site visits, at least monthly, to assess member needs and collaborate with resources as required.
  • Provide or facilitate education to long-term care members and their families or caregivers on preventive care, procedures, healthcare provider instructions, treatment options, referrals, prescribed medication regimens, and healthcare benefits.
  • Provide subject matter expertise and operational support for mental and behavioral health activities, including crisis calls, mental health first aid training, field safety and de-escalation practices, and psychotropic and other medication monitoring.
  • Educate members about and coordinate community resources, including medical, behavioral, and social services.
  • Coordinate service authorization for members and care managers for services based on service assessments and plans, including meals, employment, housing, foster care, transportation, and activities of daily living.
  • Make appropriate referrals based on individual member needs, help identify providers, specialists, and community resources, and ensure services are accessible to members.
  • Maintain accurate documentation and support the integrity of care management activities in the electronic care management system.
  • Help ensure compliance with clinical guidelines and current state and federal guidelines.
  • Provide feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members cost-effectively.
  • Perform other duties as assigned and comply with all policies and standards.

Desired Qualifications

  • Five or more years of behavioral health case management experience with child and adolescent members, preferably in inpatient psychiatric hospitals, community-based counseling programs, school or college/university settings, residential treatment centers, or local or state LIDDAs or MHAs.
  • Direct experience as a field-based case manager or social worker.
  • Experience collaborating with medical and behavioral health providers and managing community resources for Medicaid recipients.
  • Experience managing high-volume caseloads.
  • Strong clinical documentation, problem-solving, communication, attention to detail, organizational, and time-management skills.
  • Ability to adapt to changing business needs with openness, flexibility, and professionalism.
  • Experience working with government and state-sponsored programs such as STAR Kids, CHIP, Medicaid, or MDCP.

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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