Behavioral Health Care Manager I (Day Shift)

Elevance Health

4d•Remote

About The Position

Behavioral Health Care Manager I - (Day Shift) Location - Virtual: 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 accommodation is granted as required by law. Location: North Carolina and Ohio Work Shift Options: Monday-Friday 8am-5pm EST Monday-Friday 9am-6pm EST Monday-Friday 11am-8pm EST The Behavioral Health Care Manager I - (Day Shift) 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 an impact: Primary duties may include but are not limited to: 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. However, 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

Willing to get an OH License or a NC License
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
Bilingual in Spanish is highly preferred
Utilization Management experience is preferred
Previous crisis hotline is preferred
Associates in this role are expected to have 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.
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.