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Senior Care Manager
| Company | Centene |
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| Location | Miami, FL, USA |
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| Salary | $73800 – $132700 |
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| Type | Full-Time |
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| Degrees | Master’s |
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| Experience Level | Senior |
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Requirements
- Master’s degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing
- 4 – 6 years of related experience
- Licensed Master’s Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required
Responsibilities
- Develops and continuously assesses ongoing care plans/service plans of the members with high level acuity via phone or in-home visits
- 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.
Preferred Qualifications
- 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.
