You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.Superior Health Plan - STAR Health Call Center OperationsShift: Monday - Friday: 12: 30 pm - 9:00 pm (CST)100% Remote position. Applicants required to reside in the state of TexasPosition Purpose: Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.
Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome
Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members
Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans
Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs
Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met
Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
May perform on-site visits to assess member's needs and collaborates with providers or resources, as appropriate
Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits
Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
Performs other duties as assigned
Complies with all policies and standards
Education/Experience: Requires a Bachelor's degree and 1 year of related experience or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.Strongly Preferred Experience:
3 - 5 years of verifiable employment in any of the following Human and Social Services work settings: Child and Family Services, Early Child Development, Child or Adolescent Guidance and Counseling, Prekindergarten - 12 Education, Child/Adolescent Rehabilitation Counseling services, Pediatric Clinics or Hospitals, or Pediatric Home Health
Experience conducting comprehensive assessments and provision of formal healthcare/behavioral services with children, adolescents, or young adults (0 - 21) under Medicaid - STAR Health, CHIP, STAR Kids, or Foster Care or Former Foster Care
Experience working in Call Center Operations environments and managing high volume caseloads
Role requires strong adaptability, flexibility, and resiliency skills.
Professional business phone etiquette skills and proficient computer skills and experience working within large databases or provider information systems and Microsoft Office applications.
Experience working in managed care environment is a plus (Federal and State Sponsored Govt Programs), but not required
NOTE: Texas Department of Family & Protective Services (DFPS) background check is requiredPay Range: $22.07 - $37.25 per hourCentene 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.Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
