Case Manager Position Available In Miami-Dade, Florida

Case Manager in

Hialeah Job Ref:

2943741188

Employer:

Network Company Name:

Sunshine State Health Plan

Industry:

Healthcare other

Job Type:

Full Time

State:

Florida

City:

Hialeah

Zip Code:

33002

Post Date:

05/05/2025 You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Qualified candidates must be based in Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, or Washington counties in the state of Florida. This position involves travel for fieldwork, including in-home visits.

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. 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.

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 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

Pay Range:

$55,100.00 – $99,000.00 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. 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act