Behavioral Health Care Manager I - Ameriben

Elevance Health•St. Louis, MO

3d•Remote

About The Position

Behavioral Health Care Manager I - Ameriben Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. AmeriBen is a proud member of the Elevance Health family of companies. We are a third-party administrator (TPA) of medical benefits, including medical management. Hours: 8am-5pm (Local time) The Behavioral Health Care Manager I is responsible for managing adult and pediatric inpatient and outpatient psychiatric and substance abuse diagnosis. Responsible for managing substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review. Performs duties telephonically such as inpatient admission in hospitals for discharge planning and step-down needs. Responsible for communication with direct outreach to members. How you will make an impact: Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. Refers cases to Peer Reviewers as appropriate. Performs psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes to optimize member health benefits and to promote effective use of health benefits and community resources.

Requirements

Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience which would provide an equivalent background.
Current active unrestricted license, such as RN LCSW LMSW LMHC LPC LBA (as allowed by applicable state laws) LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States required.
Licensure is a requirement for this position.
(For states that do not require licensure a Board Certified Behavioral Analyst (BCBA) is also acceptable if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff supervision.)

Nice To Haves

Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.

Responsibilities

managing adult and pediatric inpatient and outpatient psychiatric and substance abuse diagnosis
managing substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review
Performs duties telephonically such as inpatient admission in hospitals for discharge planning and step-down needs
communication with direct outreach to members
Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract
Refers cases to Peer Reviewers as appropriate
Performs psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes to optimize member health benefits and to promote effective use of health benefits and community resources.