Position Purpose: Develops, assesses, plans, implements, and coordinates complex care management activities based on member needs primarily focused on behavioral health needs (including behavioral health, and social needs) to provide quality, cost-effective healthcare outcomes. Develops a personalized care plan/service plan as appropriate/required and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.
Key Details: Centene is seeking a compassionate and experienced Senior Care Manager to support the MHS Health Wisconsin plan and make a meaningful difference in the lives of members. This hybrid opportunity includes approximately 50% field-based visits throughout the Milwaukee area, offering the chance to build strong member relationships while coordinating high-quality, person-centered care. The ideal candidate will bring case management and managed care experience, familiarity with HMO and/or Medicaid plans, and knowledge of programs such as SSI and TANF. Candidates must be licensed clinicians.
Develops and continuously assesses ongoing care plans/service plans of the members with high level acuity via phone or in-home visits and works to identify providers, specialists, and community resources needed for care including mental health and social determinant needs
May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources
Coordinates and manages, as appropriate, between the member and/or family and the care provider team to ensure identified services are accessible to members
Maintains a caseload with higher volume of complex/specialty cases
Monitors member status and outcomes for changes in treatment side effects, complications and clinical symptoms and revises care plan/service plan based on member needs and issues identified including mental health and substance use disorders
Identifies problems/barriers for care coordination and appropriate care management interventions for advanced and complex cases including mental health and substance use disorders
Reviews member data to identify health risks and/or care gaps, and improve operating performance and quality care to address member’s needs/issues and provides recommendations in accordance with state and federal regulations
Reviews referrals information and intake assessments to develop appropriate care plan for complex/specialty cases
Collaborates with healthcare providers and partners (including behavioral) as appropriate to facilitate care coordination and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
Collects, documents, and maintains all 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
Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
Engages and assists new hire/preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
Performs other duties as assigned.
Complies with all policies and…