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.

• Strategic development and maintenance of clinically oriented partnerships with behavioral health 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 related to clinical utilization metrics.
• Serve as subject matter expert for behavioral health topics, including readmission and care transition, follow up after hospitalization for mental illness (FUH) and follow up after emergency department visits (FUM/FUA), utilization trends across levels of care, health equity and social drivers, and integrated behavioral health and primary care coordination.
• Participate in, coordinate, 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 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.
• Identify and implement 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.
• Support continuum of member care by identifying members in need of health education and/or services (case management, social services, etc.) and referring members to the appropriate internal department.
• Work with BH Providers on standards of care and advise providers on established clinical practice guidelines and appropriate documentation.
• Perform other duties as assigned and comply with all policies and standards.

Responsible for strategically developing clinically oriented provider and community partnerships to improve behavioral health outcomes. The Behavioral Health Clinical Practice Advisor (BHCPA) will collaborate cross-functionally with utilization management, provider relations, marketing, claims, and quality teams to deliver aligned and effective interventions that strengthen provider partnerships and system performance. This role supports provider performance improvement through data analysis, education, and on-site consultation, with a focus on improving adherence to evidence-based care.

Job duties include but are not limited to the ongoing management of BH provider office relationships, development and implementation of clinical initiatives, and participation in external and internal behavioral health related committees. This position reports to the Population Health Leadership.

• 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.
• Curr…