Senior Care Manager

Centene; United States; À distance; USD 75 000 - 135 000; Plein temps

Résumé du poste

Centene is seeking a fully remote Care Manager for behavioral health-focused case management. The role requires NY licensure (LMSW/LCSW/LMHC/LMFT or RN) and a master's degree in behavioral health or social work, plus 4–6 years of related experience.

The position emphasizes telephonic care management for high-risk members, strong clinical judgment, and the ability to collaborate across systems. Candidates should be prepared for a Monday–Friday schedule in ET with a focus on delivering quality,

Qualifications

• Master's degree in Behavioral Health or Social Work, or a Nursing degree.
• 4–6 years of related experience.
• Behavioral health experience required.
• Experience working with children and families preferred.

Responsabilités

• Develops and continuously assesses care plans for high-acuity members via phone or in-home visits, identifying providers and community resources for care.
• May conduct telephonic, digital, home or other site visits to assess member needs and coordinate resources.
• Coordinates between member/family and care provider team to ensure services are accessible.
• Maintains a high-volume caseload of complex/specialty cases.
• Monitors status and outcomes, revises care plans for changes in treatment and symptoms including mental health and substance use disorders.
• Identifies barriers to care coordination and interventions for complex cases.
• Reviews referrals and intake assessments to tailor care plans for complex cases.
• Collaborates with healthcare providers and partners to ensure timely access to care.
• Collects and maintains all member information to ensure compliance with regulations.
• Provides education to members and families on procedures, options, and benefits.
• Partners with leadership to improve care delivery cost-effectively.
• Supports onboarding and coaching of new clinical hires.

Connaissances

Clinical judgment

Active listening

Prioritization

Adaptability

Resourcefulness

Case management

Formation

Master's in Behavioral Health or Social Work

Nursing degree

Description du poste

Position Purpose

Develops, assesses, plans, implements, and coordinates complex care management activities based on member needs primarily focused on behavioral health needs (including behavioral health, and social needs) to provide quality, cost-effective healthcare outcomes. Develops a personalized care plan/service plan as appropriate/required and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.

Key Details

This is a fully remote position with a Monday-Friday schedule from 8:30 a.m. to 5:00 p.m. ET. Candidates must be licensed in New York State and hold either a Licensed Master's Behavioral Health Professional credential (such as LCSW, LMSW, LMFT, LMHC, or LPC) or an RN license, based on state contract requirements. A master's degree in behavioral health or social work, or a degree from an accredited school of nursing, along with four to six years of related experience, is required. Behavioral health experience is required, and experience working with children and families is strongly preferred. The role focuses primarily on telephonic case management and outreach for high-risk members with complex behavioral health needs and requires strong clinical judgment, active listening, prioritization, adaptability, resourcefulness, and comfort working across multiple systems.

Responsibilities

• Develops and continuously assesses ongoing care plans/service plans of the members with high level acuity via phone or in-home visits and works to identify providers, specialists, and community resources needed for care including mental health and social determinant needs
• May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources
• Coordinates and manages, as appropriate, between the member and/or family and the care provider team to ensure identified services are accessible to members
• Maintains a caseload with higher volume of complex/specialty cases
• Monitors member status and outcomes for changes in treatment side effects, complications and clinical symptoms and revises care plan/service plan based on member needs and issues identified including mental health and substance use disorders
• Identifies problems/barriers for care coordination and appropriate care management interventions for advanced and complex cases including mental health and substance use disorders
• Reviews member data to identify health risks and/or care gaps, and improve operating performance and quality care to address member's needs/issues and provides recommendations in accordance with state and federal regulations
• Reviews referrals information and intake assessments to develop appropriate care plan for complex/specialty cases
• Collaborates with healthcare providers and partners (including behavioral) as appropriate to facilitate care coordination and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
• Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs
• Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
• May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
• Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
• Engages and assists new hire/preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
• Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience

Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 4 - 6 years of related experience.

License/Certification

Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required

Pay Range

Pay Range: $75,300.00 - $135,400.00 per year

About the Employer

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible a