Position Purpose: Perform duties related to the day to day operations of the Integrated Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life for both behavioral and physical health issues.
Assess members’ current functional level and, in collaboration with the member, develop and monitor the Case Management Care Plan
Monitor quality of care; assisting with discharge planning, participating in special clinical projects and communicate with departmental and plan administrative staff to facilitate daily operations of the Integrated Case Management functions.
Collaborate with both medical and behavioral providers to ensure optimal care for members.
Conductassessmentswith patients identified as high risk, for both behavioral and physical health issues, and work with their providers to identify needs, set goals and implement action steps towards achieving goals.
Empower patients to help them improve their quality of life and ensure an integrated approach to address complex issues.
Understand and comply with NCQA guidelines and HEDIS measures
Comply with established referral, pre-certification and authorization policies, procedures and processes by related Medical Management staff
Education/Experience: Master’s degree in behavioral health and an unrestricted license as a LCSW, LMFT or LPC, or a PhD, PsyD or RN. 3+ years of case and/or utilization management experience. Experience in psychiatric and medical health care settings. Working knowledge of mental health community resources.
License/Certification: Unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN license in the applicable state.
Behavioral Case Manager must have one of theunrestricted license as listed abovefor the state of Texas.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.