LTSS Service Care Manager - Behavioral Health

About the role

Develops, assesses and coordinates holistic care management activities, with primary focus and support towards populations with significant mental/behavioral health needs, to enable quality, cost-effective healthcare outcomes.

Evaluates member service needs and develops or contributes to development of care plans/service plans, and educates members, their families and caregivers on services and benefits available to meet member needs.

Evaluates the needs of the most complex and high risk members with mental/behavioral health needs, and recommends a plan of care for the best outcome.

Acts as liaison and member advocate between the member/family, physician, and facilities/agencies.

Supports members with primarily mental/behavioral health needs, such as those with (or a history of) major depression, bipolar disorders, schizophrenia, borderline personality disorder, post-traumatic stress disorder, substance use disorder, self-injurious behavior, psychiatric inpatient admissions, etc.

Performs frequent home and/or other site visits (once a month or more), such as to assess member needs and collaborate with resources, as required.

Provides and/or facilitates education to long-term care members and their families/caregivers on topics such as preventive care, procedures, healthcare provider instructions, treatment options, referrals, prescribed medication treatment regimens, and healthcare benefits.

Provides subject matter expertise and operational support for relevant mental and behavioral health-focused activities, such as the handling of crisis calls, mental health first aid training, field safety and de-escalation practices, psychotropic and other medication monitoring, etc.

Edits on and coordinates community resources, to include medical, behavioral and social services.

Coordinates service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living).

Ensures appropriate referrals based on individual member needs and supports the identification of providers, specialists, and community resources.

Ensures identified services are accessible to members.

Maintains accurate documentation and supports the integrity of care management activities in the electronic care management system.

Works to ensure compliance with clinical guidelines as well as current state and federal guidelines.

Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.

Performs other duties as assigned.

Responsibilities

• Evaluates member service needs and develops or contributes to development of care plans/service plans, and educates members, their families and caregivers on services and benefits available to meet member needs.
• Evaluates the needs of the most complex and high risk members with mental/behavioral health needs, and recommends a plan of care for the best outcome.
• Acts as liaison and member advocate between the member/family, physician, and facilities/agencies.
• Supports members with primarily mental/behavioral health needs, such as those with (or a history of) major depression, bipolar disorders, schizophrenia, borderline personality disorder, post-traumatic stress disorder, substance use disorder, self-injurious behavior, psychiatric inpatient admissions, etc.
• Performs frequent home and/or other site visits (once a month or more), such as to assess member needs and collaborate with resources, as required.
• Provides and/or facilitates education to long-term care members and their families/caregivers on topics such as preventive care, procedures, healthcare provider instructions, treatment options, referrals, prescribed medication treatment regimens, and healthcare benefits.
• Provides subject matter expertise and operational support for relevant mental and behavioral health-focused activities, such as the handling of crisis calls, mental health first aid training, field safety and de-escalation practices, psychotropic and other medication monitoring, etc.
• Edits on and coordinates community resources, to include medical, behavioral and social services.
• Coordinates service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living).
• Ensures appropriate referrals based on individual member needs and supports the identification of providers, specialists, and community resources.
• Ensures identified services are accessible to members.
• Maintains accurate documentation and supports the integrity of care management activities in the electronic care management system.
• Works to ensure compliance with clinical guidelines as well as current state and federal guidelines.
• Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.
• Performs other duties as assigned.

Requirements

• Requires a Master's degree in Mental Health or Social Work or Graduate from an Accredited School of Nursing and 2 – 4 years of related experience.
• For Sunflower plan only: Licensed Behavioral Health Professional or RN based on state contract requirements e.g., LMSW, LCSW, LMFT, LMHC, LPC and RN with BH experience required.

Qualifications

• License/Certification For Sunflower plan only: Licensed Behavioral Health Professional or RN based on state contract requirements e.g., LMSW, LCSW, LMFT, LMHC, LPC and RN with BH experience required.

Skills

• Strong communication and interpersonal skills.
• Ability to work independently and manage multiple tasks simultaneously.
• Knowledge of behavioral health conditions and treatments.
• Proficiency in Microsoft Office applications.

Benefits

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules.

Total compensation may also include additional forms of incentives.

Benefits may be subject to program eligibility.

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.