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.Qualified Candidates must reside in FloridaPosition Purpose:Position is responsible for ensuring that the MCO's behavioral health operations, which include the operations of any MCO behavioral health subcontractors, are in compliance with the terms of the MCO's contract with the State
Coordinate with all MCO functional areas, including quality management, utilization management, network development and management, provider relations, member outreach and education, member services, contract compliance, and reporting.
Participate in all quality management and improvement activities, including participating in key State stakeholder committees.
Work closely with MCO network development and provider relations staff to develop and maintain the behavioral health network and ensure that it is fully integrated with the physical health provider network.
Partner with UM staff to monitor behavioral health utilization, especially to identify and address potential behavioral health under -or over-utilization.
Act as primary liaison with behavioral health community resources, including Community Mental Health Centers (CMHCs).
Responsible for all reporting related to the MCO’s provision of behavioral health services.
Oversee subcontracts related to behavioral health services.
Monitor the CHC-MCO for adherence to BH requirements in the Agreement.
Coordinate Participant care needs with BH Providers.
Develop processes to coordinate behavioral healthcare between PCPs and BH Providers.
Participate in the identification of best practices for BH in a primary care setting.
Coordinate behavioral care with medically necessary services.
Be knowledgeable of the BH Managed Care Agreement requirements and coordinate with the BH-MCO to effectuate the requirements.
Performs other duties as assigned.
Complies with all policies and standards
Education/Experience:Bachelor's degree in Social Services, Psychology, Health Administration, or related field. Master’s degree in a Behavioral Health specialty preferred. 5+ years related experience. Working knowledge of Medicare, Medicaid and health plan administration. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.FL License Requirement: RN, LCSW, LCMHC or other Mental Health Professional license. Drivers License RequiredPay Range: $84,300.00 - $151,700.00 per yearCentene 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.