Company

Centene Corporation

Description

You could be the one who changes everything for our 28 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.

Position Purpose Handle inbound and outbound member and provider calls on a clinical phone queue. Ensure members receive behavioral health services appropriate to clinical need. Triage crisis calls to assist with stabilization and access to emergency evaluation. Coordinate services with other departments, such as medical case/care management. Perform utilization management functions, including authorization determinations and care shaping.

Handle member calls, performing activities such as telephonic clinical assessment, determining appropriate level of care and services and answering benefit questions.

Perform utilization review functions with behavioral health providers, including care shaping and authorization determinations.

Responsible for utilization management activities with providers and/or member calls, depending on team.

Triage crisis calls, providing in-the-moment support and assisting with access to emergency services.

Use established protocols, as well as clinical judgment, to evaluate and problem solve during interactions with members and providers.

Document all calls and activities within a data management system and access multiple databases for benefit and workflow information.

Enhance clinical knowledge and skills by actively participating in all assigned training and staff meetings

Education/Experience Master’s degree in behavioral health and 3+ years of behavioral health experience (at least 2 years must be post-Master's degree). Prior managed care experience preferred. Prior experience with multiple system applications and electronic data entry, including call center and/or health care databases preferred. License/Certification Unrestricted license as Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT) or Licensed Psychologist (PhD).

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.

Pay Range $25.44 - $45.76 per hour

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

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.

Identifier

ac53065c9e5dcdc78afb6be8e3e96f87