BH Care Manager II - Utilization Management

Elevance Health • Cerritos, CA

3d • Remote

About The Position

The Behavioral Health Care Manager II, UM 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. This role enables associates to work virtually full-time, except for 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges.

Requirements

• Requires MA/MS in social work counseling or a related behavioral health field, 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 LCSW, LMSW, LMHC, LPC, LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable state(s) 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/substance abuse cases required.
• Prior managed care experience.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Nice To Haves

• California licensed clinician is highly 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.
• 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

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level