Senior Care Manager

📋 Description

• • As a Senior Care Manager at Centene Corporation, you will play a pivotal role in transforming the health of our 28 million members by developing, assessing, planning, implementing, and coordinating complex care management activities. This role is primarily focused on addressing the intricate behavioral health needs of our members, encompassing mental health and social determinants of health, to ensure the delivery of high-quality, cost-effective healthcare outcomes.
• • You will be instrumental in creating personalized care plans and service plans tailored to the unique needs of each member, providing them with the necessary support and guidance to navigate the healthcare system and access appropriate services.
• • A key responsibility involves conducting continuous assessments of ongoing care plans for members with high acuity needs. This will be achieved through various outreach methods, including telephonic communication, digital platforms, and potentially in-home or other site visits, to thoroughly evaluate member needs and identify essential providers, specialists, and community resources.
• • You will proactively coordinate and manage the care journey between members, their families or caregivers, and the care provider team, ensuring that identified services are accessible and effectively utilized.
• • This position requires managing a caseload that includes a higher volume of complex and specialty cases, demanding a sophisticated understanding of diverse health conditions and support systems.
• • A critical aspect of the role involves diligently monitoring member status and outcomes. This includes tracking changes in treatment side effects, complications, and clinical symptoms, and revising care plans or service plans as needed based on evolving member needs and identified issues, with a particular focus on mental health and substance use disorders.
• • You will be tasked with identifying systemic problems and barriers to effective care coordination and implementing appropriate care management interventions for advanced and complex cases, again with a strong emphasis on mental health and substance use disorders.
• • A data-driven approach is essential, as you will review member data to identify health risks, care gaps, and opportunities to improve operating performance and the quality of care delivered. Your recommendations will be crucial in addressing member needs and ensuring compliance with state and federal regulations.
• • You will meticulously review referral information and intake assessments to develop comprehensive and appropriate care plans for complex and specialty cases, ensuring a holistic approach to member well-being.
• • Collaboration is key. You will work closely with healthcare providers, partners, and behavioral health specialists to facilitate seamless care coordination and ensure members have timely access to necessary care and services.
• • Maintaining accurate and compliant documentation is paramount. You will collect, document, and maintain all member information and care management activities in strict accordance with current state, federal, and third-party payer regulations.
• • You will serve as an educator for members and their families, providing clear information on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, with a special focus on behavioral health and social determinant needs.
• • Partnering with the leadership team, you will contribute to the continuous improvement and enhancement of care delivery and quality for members, always with an eye towards cost-effectiveness.
• • For experienced individuals, there is an opportunity to mentor and precept clinical new hires. This involves fostering their core skills, providing coaching, facilitating their professional growth, and guiding them through the onboarding process to ensure they are upskilled and ready for success in their roles.
• • You will provide guidance and support to new hires and preceptees, helping them navigate the complexities of a Managed Care Organization (MCO) and offering coaching and shadowing opportunities to bridge the gap between theoretical training and practical field application.
• • Engaging collaboratively with new hires/preceptees throughout their onboarding journey, you will be responsible for completing competency checkpoints, ensuring their readiness for success in service coordination.
• • You will engage in a collaborative and ongoing process with People Leaders and cross-functional teams to measure and monitor the readiness of new team members.
• • Perform other duties as assigned and comply with all company policies and standards.