Position Purpose:
Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams. Assesses and performs review of member clinical records and services related to behavioral health and substance use.

Key Details: This is a remote position. Hours will align with Pacific or Mountain Time (PST/MST). Outpatient experience strongly preferred.

• Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new programs
• Partner with various staff, along with internal and external departments on provider education and outreach; determine where there are gaps and work to develop and deploy education efforts
• Partner with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data and quality incentive payments; facilitate discussions to make recommendations
• Implement and manage procedures for tracking, identifying and problem-solving operational issues, including issues between the provider network, community, and the facility, and make recommendations to solve
• Act as the clinical representative in various meetings
• Collaborate with staff to identify internal and external opportunities and initiate process changes to increase quality and improve staff, provider and member satisfaction
• Serve as resource and liaison on utilization, quality improvement and case management activities
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

Master's Degree In Social Work or Behavioral Health required
4+ years experience providing behavioral health outpatient care in a community setting or independent practice required

Experience with assessment of treatment plans related to mental health and substance abuse across the continuum of care required

Experience with managed care, case management, utilization management, or quality improvement required


Licenses/Certifications:
LCSW - Licensed Clinical Social Worker required or
LMHC - Licensed Mental Health Counselor required or
LPC - Licensed Professional Counselor required or
LMFT - Licensed Marital and Family Therapist required or
LMHP - Licensed Mental Health Professional required or

Licensed Clinical Psychologist required or:
*State specific licensure may be required for the following states: AZ, FL, GA, NV, SC, NC, and WA required
 

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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