Behavioral Health Care Manager I

Elevance Health•Sacramento, CA

4d•$70,664 - $110,814•Remote

About The Position

The Behavioral Health Care Manager I 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. 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

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 LCSW, LMSW, LMHC, LPC LMFT, RN or Clinical Psychologist to practice as a health professional within the scope of licensure from the state of Washington is required.
Proficient in Microsoft Office Suite (including Word and Outlook).
Ability to quickly learn and adapt to new technologies.
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Nice To Haves

Experience with facility-based treatment, either provider or managed care, is strongly preferred.
Previous utilization review/utilization management 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.