You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
Qualified applicants must reside in Arizona. This is a field based role with up to 90% travel to visit members.
Position Purpose:
Oversees the long-term care plans/service plans and care management activities to enable quality, cost- effective healthcare outcomes. Reviews and provides expert knowledge to inform personalized care plan/service plan as appropriate/required for long-term care members and provides guidance and/or support to the care management team.
- Oversees and reviews ongoing long-term care plans/service plans and works with care management team to identify providers, specialist, and/or community resources needed for long- term care
- Provides insight and guidance on developing service plans/care plans and triaging issues to appropriate healthcare providers for complex service plans/care plans
- Provides guidance and expert knowledge as appropriate to team members to ensure quality control over work, that member needs are being met, and adherence to internal and contract policies and procedures
- Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans
- Monitors complex care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs
- Provides subject matter expertise insights for complex long-term care plans/service plans based on prior experience to recommend enhanced member care within the care management plan
- Reviews member data to identify trends and improve operating performance and quality care and provides recommendations in accordance with state and federal regulations, as required
- Partners and collaborates with healthcare providers/partners regarding complex LTSS cases as appropriate to facilitate member's services, as required
- May perform home and/or other site visits to assess member's needs and collaborate with healthcare providers and partners
- Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
- Provides training and education to care management team and/or providers to ensure members are receiving high quality care and information regarding treatment plan options, procedures, referrals, and healthcare benefits
- Partners with leadership team 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
Education/Experience: Requires a Bachelor's degree and 5 - 7 years of related experience or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
License/Certification:
Licensed Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMFT, LMHC, LPC and RN with BH experience required
Pay Range: $34.81 - $62.54 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
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.
