Behavioral Health Care Manager I

Elevance Health•Durham, NC

1d•Remote

About The Position

The Behavioral Health Care Manager I is responsible for assessing the clinical need of a provider’s request for a beneficiary to receive the 1915i waiver by reviewing the provider’s assessment submitted for support services in collaboration with North Carolina Medicaid.

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 either a RN, LCSW, LCMHC, LPC, LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in the state of North Carolina is a requirement for this position.

Nice To Haves

Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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.
Performs 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.