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Company Name : Superior HealthPlan
Location : Texas
Position : Behavioral Case Mgr – Remote Texas
Job Description : You could be the one who changes everything for our 25 million members as a Behavioral Case Manager on the Clinical team. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national Fortune 24 and rapidly growing organization, exceptional talent fuels our mission.
Do you thrive in a supportive, result-oriented community and are committed to the relentless pursuit of continuous growth? As part of our clinical group, the member-focused care you deliver will make a difference and change the face of healthcare for Texas. Are you ready to make an impact?
As a Behavioral Case Manager, you will:
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.
Work telephonically with patients identified as high risk, for both behavioral and physical health issues, and 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.
Each position will be the delegated agency’s single point of contact to coordinate the overall CM activities provided to the target population
Review and approve the initial and ongoing assessment and care plan to ensure requirements are met
Coordinate service request/authorizations with UM and ensure agreement is aligned between the member, agency, and MCO
Facilitate member linkages to MCO-based services and programs in collaboration w/ agency staff
Assist members and/or agency staff w/ transportation to healthcare appointments
Communicate status of member health indicators with agency staff that can contribute the successful community living of members
Participate in weekly rounds w/ agency staff
Other duties as assigned
Our Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work schedules and dress flexibility
Competitive pay
Paid Time Off including paid holidays
Health insurance coverage for you and dependents
401(k) and stock purchase plans
Tuition reimbursement and best-in-class training and development
In-person and virtual training following State and Community guidelines
About Centene:
We are an industry leader with a local focus and a global vision:
We are a diversified, multi-national, inclusive healthcare company delivering relevant, technology-driven solutions at the global, national, and local levels
Listed on Fortune magazine’s World’s Most Admired Companies List for 2nd consecutive year
National footprint across all 50 states, serving 1 in 15 individuals in the U.S.
Recognized as one of the Best Places to Work by the Human Rights Campaign Foundation
Education/Experience:
Master’s degree in behavioral health and an unrestricted license as a LCSW, LMFT or LPC, 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, or RN license in applicable state.
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.
This post is listed Under Texas jobs
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