Position Purpose:
Works with members and providers to close behavioral health care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through targeted member and provider outreach. Serves to collaborate with members and providers, to improve behavioral health HEDIS measures. Supports the implementation of quality improvement behavioral health interventions with identified members. Assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS. Conducts telephonic outreach, to members who are identified as needing behavioral health services in support of quality initiatives and regulatory/contractual requirements. Provides education to members regarding the care gaps they have. Schedules doctor appointments on behalf of the practitioner and assists member with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available. Maintains confidentiality of business and protected health information. Provides coaching and training to new and current Quality Behavioral Health Advocates. Assist supervisor with special projects and implementing new initiatives towards better practice within the department as it pertains to day-to-day operations and technical resources. Acts as the team lead and source of information in supervisor's absence.
Key Details: This position is remote/work from home; applicants must reside in the state of Florida and hold an active, current, unrestricted LCSW, LMFT, LMHC or LPC licensure. This role is part of Quality Improvement and will telephonically out reach to Medicaid members who were recently discharged from the Emergency Room/ED.
- Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
- Directly closes FUH, FUM, and FUA HEDIS care gaps with identified members.
- Assist members in getting connected to their behavioral health provider and/or assists members in finding a behavioral health provider for ongoing services.
- Schedules doctor appointments for members with behavioral health care gaps to access needed care services and close gaps in care.
- Conducts telephonic education with the member and their family, about care gaps identified, and barriers to care.
- Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements.
- Arranges transportation for members as needed.
- Arranges follow-up appointments for members as needed.
- Documents all actions taken regarding contact related to member.
- Interacts with other departments including customer service to resolve member issues.
- Refers to case or disease management as appropriate.
- Completes special assignments and projects instrumental to the function of the department.
- Performs other duties as assigned.
- Acts as subject matter expert in regards to required departmental best practice, reports and data extract
- Takes lead on preparing and submitting projects, reports or assignments as needed to meet department initiatives.
- Assists with implementation of new and expanding health care QI/HEDIS initiatives.
- Represents supervisor in meetings or on special assignments.
- Helps establish process improvements leading to best practice and assist in implementing change movement within the department.
- Conducts audits and chart reviews on fellow Quality Behavioral Health Advocates to ensure best practice and proper protocol.
- Participates in and represents the plan at community, health department, collaborative and other organizational meetings focusing on quality improvement.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2 – 4 years of related experience.
License/Certification:
- Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience 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