Behavioral Health Clinical Practice Advisor

Overview

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.

• Schedule:
  Mon–Fri, 8:00 a.m.–5:00 p.m., flexible for provider visits and cross-functional meetings.
• No weekends/evenings/holidays.
• Travel: 30% within Nevada.
• Active Nevada clinical license (LCSW, LMFT, LPC, PsyD, or equivalent).
• 3+ years BH and/or managed care; experience in provider training, performance improvement, and/or UM.
• Strong claims/utilization analytics + clear facilitation/communication.
• Self-directed and comfortable in a field-based hybrid role.
• Position purpose:
  Strategic development and maintenance of clinical oriented partnerships with BH providers, hospital systems, and community-based organizations to improve behavioral health outcomes.
• Design and implement practice level performance improvement projects including providing education to providers and office staff on proper clinical documentation, coding and billing practices that relate to clinical utilization metrics.
• Serve as subject matter expert for behavioral health topics, including:
  Behavioral health readmission and care transition, follow up after hospitalization for mental illness (FUH) and Follow up after emergency room visit (FUM/FUA) performance, utilization trends across levels of care, health equity and social drivers and integrated behavioral health and primary care coordination.
• Participate, coordinate, and or represent the health plan at community-based organization events, and committees focused on improving member outcomes, education, quality improvement and other programs.
• Develop and design educational content and resource materials focused on improving behavioral health care, better member outcomes, and other related topics.
• Ability to travel to physicians  offices locally 75% of the time. Able to travel to Northern and rural Nevada to meet with BH and other community-based organizations.
• Provide expert direction and guidance on provider-focused clinical utilization and quality improvement programs.
• Identifies and creates improvement strategies for population-based barriers to access to timely and appropriate care, continuity of care and transitions between care settings, preventive and early intervention services and disparities in behavioral health outcomes across populations.
• Supports continuum of member care by identifying members in need of health education and/or services (case management, social services, etc.) and refers members to the appropriate internal department.
• Works with BH Providers on standards of care and advises providers on established clinical practice guidelines, and appropriate documentation.
• Performs other duties as assigned.
• Complies with all policies and standards.

• Master s Degree in Social work or related field required
• 3+ years Clinical experience in behavioral health care delivery required

• Knowledge of one or more of:
  Clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry preferred
• Licenses/Certifications:
• Current/unrestricted clinical license in the state of Nevada required
• LCSW
  - License Clinical Social Worker Upon Hire preferred
• Licensed Marital and Family Therapist (LMFT) Upon Hire
• LPC-Licensed Professional Counselor Upon Hire
• PSY - Psychologist Upon Hire

Pay Range: $70,100.00 - $ 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, 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