Job Profile Summary:
Position Purpose:
Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder.
Education/Experience:
Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2 4 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
For Illinois Youth Care plan only: Graduate degree and independently licensed behavioral health clinician (e.g. LCSW, LCPC, PsyD) in Illinois or Bachelor s Degree and IL RN licensure. Must reside in IL required
For NJ Health Plan Only: Requires a Master's degree in Behavioral Health or Social Work and a Licensed Associate Counselor (LAC) or Licensed Social Worker (LSW) required
For Sunshine Health (FL) Only: Employees supporting Florida's Children s Medical Services must Hold a Master s degree in social work or related field and have one year of related professional pediatric care experience. May require up to 80% local travel required
Responsibilities:
Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs
May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources
Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders
Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members
Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs
Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services
Collects, documents, and maintains 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
Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
Performs other duties as assigned.
Complies with all policies and standards.
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
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Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder.- Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs
- May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources
- Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders
- Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members
- Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs
- Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services
- Collects, documents, and maintains 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
- Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
- Performs other duties as assigned.
- Complies with all policies and standards.
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| Story Behind the Need |
- What is the purpose of this team?
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
| This is a need to quickly provide support to the adoption subsidy/DYS team within the Home State Health Show Me Healthy Kids specialty plan with behavioral health care management cases. We have had multiple staff vacancies for the care manager position at one time and need someone who can join the team quickly. The typical cases that they manage are children/adolescents who require extra support included but are not limited to: frequent inpatient psychiatric hospitalizations, autism/developmental delay diagnoses, aggression/oppositional defiant disorder, and need for residential behavioral health treatment. |
| Typical Day in the Role |
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
| Daily schedule: Monday-Friday 8:00 am-5:00 pm CST, 1 hour lunch break. No overtime, weekends or holidays.
Day-to-day responsibilities and description of the project: Care manager will be outreaching parents/guardians and members (for those aged 18+) to complete health risk screening assessments, post-hospital discharge assessments, and to complete care management enrollment calls and care management follow-up calls. Care management enrollment includes going over diagnoses, clinical and treatment history, medications, legal issues, social concerns, community resources, care gaps, and setting up personalized care plan goals. Follow-up calls go over progress towards the goals. Care manager will provide verbal education and resources to assist the parents/members. Each assessment and note will be documented in detail to meet compliance and auditing requirements. This role also includes communicating with Children s Division and parents via email securely.
Performance expectations/metrics: 60-80 BH CM cases with 20% of cases being complex. Less than 20 care coordination cases with fewer needs. Daily productivity expectation of 14 calls per day with greater than 30% success rate, audit expectation of 95% and above. Must be able to prioritize tasks for compliance.
Interaction level with team: Fully integrated and involved in the team, team meetings and expectations.
Work environment: Fully remote work-from-home. Must have private office space due to HIPAA laws and privacy needs. Interaction with team takes place regularly virtually through Microsoft Teams messages and calls.
What makes this role unique: This is a fully remote, work from home position with no field based or in person member visits. All member engagement is conducted telephonically. The role also offers growth potential within Centene, as employees who demonstrate strong performance and competency may have opportunities to advance across the organization s multiple markets and departments upon conversion to full time employment. |
| Candidate Requirements |
| Education/Certification | Required: Master s degree in behavioral health or social work | Preferred: MSW |
| Licensure | Required: LCSW, LMSW, LPC | Preferred: LCSW |
Years of experience required: 2 years post-Master s work required, ideally would have 5+ years.
Disqualifiers: Lack of required licensure. No behavioral health experience.
Additional qualities to look for: Managed care experience, hospital or community mental health center case management experience, working remote |
- Top 3 must-have hard skills stack-ranked by importance
| 1 | Ability to manage multiple tasks and priorities in a fast-paced, remote environment. |
| 2 | Behavioral health case management experience. |
| 3 | Ability to document accurately and in real time while speaking with members using electronic documentation systems. |
| Candidate Review & Selection |
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
| Projected Manager Candidate Review Date: | 1-2 days post shortlisting |
Type of Interviews:
| Virtual interviews on Microsoft Teams- Cameras On |
| Required Testing or Assessment (by Vendor): | None |
| Next Steps |
- Do you have any upcoming PTO?
| None planned at this time |
- Colleagues to cc/delegate
| Kimberly Kirklin, Miranda Smith |
| Compliance Questions |