Job 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.

***** This role is primarily remote with occasional in-person collaboration. Quarterly team meetings are held at our Bedford, NH office, and up to 10% travel to regional provider offices may be required. Candidates must reside in the New England region. *****

Position Purpose:

Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams. Assesses and performs review of member clinical records and services related to behavioral health and substance use.

• Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new programs

• Partner with various staff, along with internal and external departments on provider education and outreach; determine where there are gaps and work to develop and deploy education efforts

• Partner with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data and quality incentive payments; facilitate discussions to make recommendations

• Implement and manage procedures for tracking, identifying and problem-solving operational issues, including issues between the provider network, community, and the facility, and make recommendations to solve

• Act as the clinical representative in various meetings

• Collaborate with staff to identify internal and external opportunities and initiate process changes to increase quality and improve staff, provider and member satisfaction

• Serve as resource and liaison on utilization, quality improvement and case management activities

• For NH Health Plan Only: Perform Behavior Health provider audits and technical assistance activities. Track and monitor outcomes and opportunities for improvement. Participate with the BH program functions and operations. Participate in exhibit O or any additional reporting requirements. Local travel required for in-person events, projects, auditing and community engagement activities

• Performs other duties as assigned.

• Complies with all policies and standards.

Education/Experience:

Master's Degree In Social Work or Behavioral Health required.

• 4+ years experience providing behavioral health outpatient care in a community setting or independent practice required

• Experience with assessment of treatment plans related to mental health and substance abuse across the continuum of care required

• Experience with managed care, case management, utilization management, or quality improvement required

• For Applied Behavior Analysis Services (ABA) 2+ years of experience providing ABA services required

• Behavioral health clinical knowledge and ability to review and/or assess ABA treatment plans required

• Knowledge of ABA services required

• Experience working with providers and healthcare teams to review care services related to Applied Behavioral Analysis Services preferred

Licenses/Certifications:

• LCSW - Licensed Clinical Social Worker required or

• LMHC - Licensed Mental Health Counselor required or

• LPC - Licensed Professional Counselor required or

• LMFT - Licensed Marital and Family Therapist required or

• LMHP - Licensed Mental Health Professional required or

Licensed Clinical Psychologist required or:

* State specific licensure may be required for the following states: AZ, FL, GA, NV, SC, NC, and WA required or

For Applied Behavior Analysis Service (ABA) Board Certified Behavior Analyst (BCBA) preferred: Licensed Behavior Analyst (LBA) where required by state

Pay Range: $68,700.00 - $123,700.00 per year

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, including full-time or part-time status. 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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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