You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Assure compliance with established referral, pre-certification and authorization policies, procedures and processes by related Medical Services staff.
Assure compliance with established onsite and concurrent review, case management, referral, pre-certification and authorization policies, procedures and processes.
Assure compliance with emergency management policies, procedures and processes.
Facilitate on-going communication between case management staff, utilization management staff and contracted providers.
Assist with the implementation of policies and procedures regarding medical case management.
Maintain compliance with federal and state regulations and contractual agreements.
Coordinate and communicate medical service functions with other departmental functions.
Act as medical resource for appeals function.
Assist Medical Services staff with computer systems issues related to case management.
Conduct telephonic review of cases with doctors, hospitals, and other providers.
Compile and review multiple reports for statistical and financial tracking purposes to identify case management trends and assist in financial forecasting.

Position Purpose: Conducts comprehensive member psychosocial assessments through root cause analysis and performs clinical intervention through the development of a care management treatment plan specific to each member with high level acuity needs. Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Assess members to recommend activities and behavioral routines to meet the social and medical needs of members and their families. Provides support and/or intervention and assists members in understanding the implications and complexities of their current medical situation and/or overall personal care.

Candidate Education: Required A Master's Degree in Social Work, Psychology, Counseling, Rehabilitation, or other relevant field that provides a foundation to receive a license as required of the position

Candidate Experience: Required 2+ years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning
Required 1+ year of experience in current case management as a licensed professional

Required Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs. Preferred Experience in a managed care environment.

Licenses and Certifications: A license in one of the following is required: A master's level independent or non-independent license is required OR an RN with a behavioral health background:

FL License Requirement: RN, LCSW, LCMHC or other Mental Health Professional license

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.