Plan Design Specialist jobs in Jacksonville, FL

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.

Position Purpose: Conduct screening and risk assessment interventions per program guidelines. Act as primary liaison for members and staff. Assist with aspects of the member’s care, including referrals to community resources.

• Identify special needs members through the completion of health screens and other resources
• Work with community outreach/member advocates to coordinate member care
• Educate providers and community resources on program components and available support services
• Educate members with special needs to foster compliance with program and positively impact outcomes
• Conduct site visits as appropriate for programs and provide support to other special programs
• Develop and modify care plans in conjunction with member, member’s family and managing physician
• Development of plan specific literature and education materials in conjunction with medical director and corporate oversight
• For Michigan Complete Health - home visits required

Education/Experience: Bachelor’s degree in Social Work, Nursing, Health, Behavioral Science or equivalent experience. Master’s degree in Social Work preferred. 4 years of community experience in directly managing and integrating the social/community needs of the members. Experience in a managed care environment or working with people with disabilities and vulnerable populations who have chronic and complex conditions.

License/Certification: Valid driver’s license, except not required for Indiana. RN (Registered Nurse), LCSW (Licensed Certified Social Worker), LPN (Licensed Practical Nurse), Occupational Therapy (OT), Physical Therapy (PT), or LVN (Licensed Vocational Nurse) preferred.

For Illinois YouthCare plan only: Candidates are required to live within the specified region.

Requirements for the state of New Hampshire focused on Housing: Individual shall be responsible for helping to identify, secure, and maintain community based housing for Members and developing, articulating, and implementing a broader housing strategy within the MCO to expand housing availability/options. The Housing Coordinator shall act as the MCO’s central housing expert/resource, providing education and assistance to all MCO’s relevant staff (care managers and others) regarding supportive housing services and related issues. The Housing Coordinator shall be a dedicated staff person whose primary responsibility is housing-related work. The Housing Specialist shall not be a staff person to whom housing-related work has been added to their existing responsibilities and function within the MCO. The Housing Coordinator shall act as a liaison with the Department’s Bureau of Housing and Homeless Services to receive training and work in collaboration on capacity requirements/building. The Housing Specialist shall have at least two (2) year’s full-time experience is assisting vulnerable populations to secure accessible, affordable housing. The Coordinator must be familiar with the relevant public and private housing resources and stakeholders.

Requirements for the state of New Hampshire focused on Special Needs:
Education/Experience: Master's Degree from a recognized college or university with major study in Social Work, Psychology, Education, Public Health or a related field. 8 years of demonstrated experience both in the provision of direct care services as well as progressively increasing levels of management responsibilities with a particular focus on special needs populations

Requirements for the state of New Hampshire focused on Developmental Disabilities:
Education/Experience: Master's Degree from a recognized college or university with major study in Social Work, Psychology, Education, Public Health or a related field. 8 years of demonstrated experience both in the provision of direct care services as well as progressively increasing levels of management responsibilities, with a particular focus on direct care and administrative responsibilities related to services provided for developmentally disabled individuals.

Requirements for the state of New Hampshire focused on Long Term Services:
Education/Experience: Master’s Degree in a Social Work, Psychology, Education, Public Health or a LTSS related field and have a 8 years of demonstrated experience both in the provision of direct care services at progressively increasing levels of management responsibilities, with a particular focus on direct care and administrative.

For Michigan Complete Health: RN, licensed nurse practitioner, licensed physician's assistant, licensed Bachelor's prepared social worker, limited license Master's prepared social worker, or licensed Master's prepared social worker. Valid driver's license required.

For Trillium: RN, Master’s prepared Social Worker with ability to apply for licensure in Oregon (license required to start), Licensed Professional Counselor (LPC), Oregon Licensed Social Worker (LSW), Active- Licensed Practical Nurse (LPN) in Oregon (or ability to get licensed). Valid Driver’s License.

For Federal Services: Licensed Bachelor’s or Masters Prepared Social Worker; LSW, LCSW, LICSW or LMSW

For Sunshine Health (FL): Employees supporting Florida's Children’s Medical Services (CMS) must be a Florida licensed registered nurse with a minimum of two years of pediatric experience, Florida licensed practical nurse with a minimum of four years of pediatric experience, or a Master’s degree in social work with a minimum of one year of related professional pediatric care experience. May require up to 80% local travel.

For Fidelis Care: NYS Licensed Master Social Work (LMSW) or NYS Licensed Clinical Social Worker (LCSW).Pay Range: $25.97 - $46.68 per hour

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. 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.