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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.

This is a remote/work-from-home position where local travel is required for member visits. Candidates must reside in Hidalgo or Starr County, TX to be considered for the role.

Position Purpose: : Perform duties related to the day-to-day operations of the Service Management functions for STAR Kids members to achieve the highest possible levels of functioning and wellness by ensuring consistent, timely access to medically necessary behavioral health services. Monitor quality of care, assist with discharge planning.

• Work with STAR Kids Members, Medical Consenters, Department of Family and Protective Services (DFPS) staff and providers to meet the behavioral healthcare needs of each STAR Kids member’s condition.

• Identify STAR Kids members who may benefit from service management, conduct an assessment and develop, implement and monitor a healthcare service plan.

• Update database regularly with most recent Service Management Plan of Care.

• Review information submitted by providers into the database to ensure material is appropriate and consistent with guidelines for data inclusion.

• Encourage behavioral health providers to use evidence-based practices and confirm that behavioral health providers and PCP’s are sharing information as required.

• Comply with established referral, pre-certification and authorization policies, procedures and processes by related medical management staff.

• Maintain compliance with federal and state regulations and contractual agreements.

• Coordinate service management functions with other departmental functions.

• Monitor data to address trends or potential quality improvement opportunities.

• Maintain HIPAA compliance.

Education/Experience: Master's degree in Behavioral Health. 3+ years of case and/or utilization management experience. Experience in psychiatric health care settings, child behavioral health conditions and members with special needs. Working knowledge of utilization review procedures, and familiarity with mental health community resources. Thorough knowledge of a specialized or technical field such as clinical nursing, case and/or utilization management involving knowledge plus the application of basic theory. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Foster care experience strongly preferred.

License/Certification: Unrestricted license as a LCSW, LMFT, LMHC, LPC, PhD, PsyD or RN.

For Superior Health Only:

Education/Experience: No previous experience with Foster care, child behavioral health conditions, or members with special needs. Previous experience acting as a lead in a functional area, managing cross functional teams on a large scale project, or supervisory experience including hiring, training, assigning work and managing the performance of staff, preferred but not required.

DFPS background check required

Pay Range: $25.97 - $46.68 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

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.