Behavioral Health Care Manager I, Utilization Management

Elevance Health•Cerritos, CA

1d•Remote

About The Position

Behavioral Health Care Manager I, Utilization Management Work Hours M-F 8am-5pm PST Work Location: Virtual, California This role enables associates to work virtually full-time, except for 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. The Behavioral Health Care Manager I, Utilization Management is responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review. How you will make a difference: 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 California license, such as RN LCSW LMHC LPC LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in California required

Nice To Haves

Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Crisis call center experience is preferred.
UM experience strongly preferred.
Managed Care experience is preferred.

Responsibilities

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.