Behavioral Health Care Manager I

Elevance Health•Durham, NC

13d•Remote

About The Position

Responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review. This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), 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 accommodation is granted as required by law.

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 (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.
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required.
Prior managed care experience required.

Nice To Haves

Bilingual Spanish/English preferred.
Medicaid, Foster care or high-risk population experience
Utilization Management (UM) experience.
Managed care or health plan experience.
Ability to work in a fast-paced, metric-driven environment.
Experience with high-volume caseloads or calls.
Familiarity with care management systems (e.g., CareRadius, Facets).
Strong communication, documentation, and teamwork skills.
Must be proficient in MS Office and have a strong technical aptitude.

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.