Behavioral Health Care Manager II

Elevance Health•Durham, NC

2d•Remote

About The Position

Responsible for managing psychiatric 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. 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 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. Will serve as a resource to other BH Care Managers. Assists with more complex cases and may participate in inter and intradepartmental teams’ projects and initiatives.

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 treatment; or any combination of education and experience which would provide an equivalent background.
Current active unrestricted license such as LBA (as allowed by applicable state laws) 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 cases required.
Prior managed care experience required.

Nice To Haves

Previous experience as a BCBA with a focus in Applied Behavior Analysis (ABA).
Candidates may reside in any state; however, they must be within a reasonable commuting distance of a designated Pulse Point office location.

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 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.
Will serve as a resource to other BH Care Managers.
Assists with more complex cases and may participate in inter and intradepartmental teams’ projects and initiatives.