Clinical – Care Manager – J01006 Care Manager – J01006 Position Available In St. Louis, Missouri

Clinical

• Care Manager
• J01006 Care Manager
• J01006#25-61801
  Clayton, MO
  All On-site Job Description

Job Description:

Job Profile Summary:

Position Purpose:

Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder.

Education/Experience:

Requires a Master’s degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2

• 4 years of related experience.

License/Certification:

Licensed Master’s Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required For Illinois Youth Care plan only: Graduate degree and independently licensed behavioral health clinician (e.g. LCSW, LCPC, PsyD) in Illinois or Bachelor’s Degree and IL RN licensure. Must reside in IL required

For NJ Health Plan Only:

Requires a Master’s degree in Behavioral Health or Social Work and a Licensed Associate Counselor (LAC) or Licensed Social Worker (LSW) required 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. May require up to 80% local travel required

Responsibilities:

Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services Collects, documents, and maintains 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 Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
Performs other duties as assigned. Complies with all policies and standards.
Comments for

Vendors:

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of

• Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.” ========
  Centene Job Description Story Behind the Need
• Business Group & Key Projects Health plan or business unit
  Team culture
  Surrounding team & key projects
  Purpose of this team
  Reason for the request
  Motivators for this need
  Any additional upcoming hiring needs?

This is a need to replace a behavioral health care manager who will be going on maternity leave in May 2025 and will support the adoption subsidy/DYS team within the Home State Health Show Me Healthy Kids specialty plan with behavioral health care management cases. The typical cases that they manage are children/adolescents who require extra support included but are not limited to: frequent inpatient psychiatric hospitalizations, autism/developmental delay diagnoses, aggression/oppositional defiant disorder, and need for residential behavioral health treatment.
Typical Day in the Role Daily schedule & OT expectations
Typical task breakdown and rhythm
Interaction level with team
Work environment description Daily schedule: Monday-Friday 8:00 am-5:00 pm CST, 1 hour lunch break. No overtime, weekends or holidays.
Typical task breakdown and rhythm: 60-80 BH CM cases with 20% of cases being complex. Less than 20 care coordination cases with fewer needs. Productivity expectation of 14 calls per day, audit expectation of 95% and above. Must be able to prioritize tasks for compliance.
Interaction level with team: Fully integrated and involved in the team, team meetings and expectations.
Work environment: Fully remote work-from-home. Must have private office space due to HIPAA laws and privacy needs. Interaction with team takes place regularly virtually through Microsoft Teams messages and calls.
Compelling Story & Candidate Value Proposition What makes this role interesting?
Points about team culture
Competitive market comparison
Unique selling points
Value added or experience gained This is a fully remote work-from-home position that does not include field visits to see members in the community. Interaction with members is telephonic only. There is room for growth within the company of Centene since we have so many markets and departments if competence is displayed at this role and the employee converts to full time work.
Candidate Requirements
Education/Certification

Required:

Master’s degree in behavioral health or social work

Preferred:

MSW
Licensure

Required:

LCSW, LMSW, LPC

Preferred:

LCSW Years of experience required
Disqualifiers
Best vs. average
Performance indicators Must haves: 2-4 years Nice to haves: 5+ years

Disqualifiers:

No license or behavioral health/medical experience.

Performance indicators:

14 calls to members per day, 95%+ score on clinical quality audits. Best vs.

average:

Case management experience & social worker BEST Top 3 must-have hard skills
Level of experience with each
Stack-ranked by importance
Candidate Review & Selection 1 Case management experience
2 Experienced with using multiple technologies/platforms including Microsoft Teams, clinical documentation systems.
3 Resource management and advocacy
Candidate Review & Selection Shortlisting process
Second touchpoint for feedback
Interview Information

Onboard Process and Expectations Projected HM Candidate Review Date:

2/19

Number and Type of Interviews:

Virtual interviews on Microsoft Teams

CAMERA ON

Extra Interview Prep for

Candidate:

Required Testing or Assessment (by Vendor): Manager Communication Preferences & Steps Background Check Requirements (List DFPS or other specialty checks here) Background check required, no specialty checks. Do you have any upcoming PTO? Colleagues to cc/delegate TBD