Clinical Supervisor - Centene Corporation (Austin, Texas)

City: Austin
State: Texas
Country: USA

Company Name: Centene Corporation
Job Category: Medical/Healthcare

Centene Corporation is a leading multi-line healthcare enterprise that provides managed-care programs and related services to individuals receiving benefits under Medicaid, including Supplemental Security Income (SSI) and the State Childrens Health Insurance Program (SCHIP).Position Purpose:Perform duties to supervise the day-to-day operations of the case management and utilization management functions; communicate with departmental and plan administrative staff to facilitate daily operations of the High Risk Case Management and Utilization Management functions.Knowledge/Experience:Masters degree in behavioral health field or RN required. Unrestricted licensed as a LCSW, LMFT or LPC, or a PhD, PsyD or RN. Thorough knowledge of a specialized or technical field such as clinical nursing, case and/or utilization management involving knowledge plus the application of basic theory. Experience in psychiatric health care settings including utilization review. Knowledge of utilization review procedures, and familiarity with mental health community resources. 3-5 years case and/or utilization management. Supervisory experience preferred.Position Responsibilities: Oversee the workflow and day-to-day operations of the high risk case management and utilization management functions including supervising staff. Ensure compliance with established referral, pre-certification and authorization policies, procedures and processes by staff. Ensure compliance with established initial and concurrent review, care management, referral, pre-certification and authorization policies, procedures and processes. Ensure compliance with plans emergency management policies, procedures and processes by acting as liaison with other business units. Facilitate on-going communication between case management staff, utilization management staff and contracted providers. Assist with the implementation of policies and procedures regarding case management and utilization management functions. Maintain compliance with federal and state regulations and contractual agreements. Supervise first level appeals function. Provide oversight of telephonic review of inpatient admissions with doctors, hospitals, and other providers. Monitor the effectiveness of existing procedures and outreach/intervention efforts. Ensure appropriate medical necessity review at all locations. Coordinate physicians review for adverse determination. Ensure appropriate knowledge/education and interventions are conducted for members defined to be at risk. Monitor data to address trends or potential quality improvement opportunities including provider issues, service gaps, member needs. Ensure HIPAA compiance.License/Certificates: Unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN licensed in applicable state(s).3 or more years of experience