Job Description

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.

    • Responsible for strategically developing clinical oriented provider and community partnerships in order 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, participation in external and internal behavioral health related committees. This position reports to the Population Health Leadership.

    Education/Experience:
    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 - $126,200.00 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.

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