Behavioral Health Care Manager II
About The Position
JR169828 Behavioral Health Care Manager II Responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review. The BH Care Manager (UM) job progression is primarily a provider-facing role although it does involve some member facing activities such as providing verbal notifications. Location: Virtual: 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. Shift: Monday-Friday 8:30AM-5:00PM EST How will you make an impact: 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. 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 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 or (as allowed by applicable state laws) LMFT 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 utilization management with a broad range of experience with complex psychiatric/substance abuse cases required.
- Prior managed care experience required.
Nice To Haves
- Associates in this role should have excellent oral and written communication skills, with strong interpersonal abilities. They should also possess exceptional problem-solving, facilitation, independent decision-making, and analytical skills.
- Proficiency in MS Office and a strong technical aptitude are essential.
- A valid New York license is necessary for this position. Applicants residing in the New York, New Jersey, and Connecticut tri-state area must hold this license.
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.
- 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.
Benefits
- In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
- We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Insurance Carriers and Related Activities
Number of Employees
5,001-10,000 employees
