Manager, Behavioral Health Case Management

Blue Cross and Blue Shield of North Carolina • Remote Flex - North Carolina, NC

3d • $107,901 - $172,642

About The Position

We’re hiring a Manager, Behavioral Health Case Management, to collaborate and engage with multiple internal stakeholders and external customers (i.e. providers, vendors, employer groups) to implement population health management and promote a collaborative, integrated culture across lines of business/segments. You will support value-based strategy by leading multiple clinical or non-clinical teams/staff focused on improving member health through proactive and professional services in the following areas: clinical determinations, case management, disease management, wellness, medical policy, medical review, and/or related services.

Requirements

• Bachelor’s degree and 8+ years of relevant experience.
• If no degree, at least 10 years of relevant experience.
• For Behavioral Health specific roles, another applicable licensure will be considered (LMSW, LCSW, LPC, LMFT, etc.)

Nice To Haves

• Must have valid NC license or multistate compact license
• 3+ years of direct supervisory or leadership experience
• Experience in population health, care management, clinical review or coding, or utilization management in a health care organization/system or health insurance

Responsibilities

• Assist in the development of operational strategies and innovative solutions for area(s) of clinical oversight; facilitate favorable medical expense, administrative pricing and/or efficiencies.
• Maintain awareness of trends, developments, and governmental regulations in managed health care organizations and product line(s) under leadership purview and recommend associated policy positions, new initiatives and/or existing program changes to improve the company’s competitive position.
• Use competitive intelligence to guide, consult and drive strategic program and product development and management
• Manage the operational performance of multiple integrated clinical functions including Clinical Determinations, Case Management, Disease Management, Wellness, Medical Policy, Medical Review and/or related services for different line(s) of business to ensure performance standards are met and in compliance with employer groups, FEP Directors’ Office, and/or applicable state and federal regulations.
• Initiate and manage service initiatives/programs to facilitate and promote quality, cost effective outcomes and minimize the impact of fragmented health care delivery on the customers.
• Collaborate and integrate with internal and external customers to deliver a fully integrated care delivery model and seamless member experience and investigations or escalated/high profile cases; troubleshoot and provide guidance to staff to ensure resolutions and improved customer experience.
• Facilitate and incorporate complex clinical and financial decision making in the day-to-day operations by presenting thoroughly analyzed cases requiring high administrative approval or intervention.
• Establish and monitor performance and production metrics and goals, including process measures, outcomes measures and financial measures.
• Manage, and/or support implementation of departmental, divisional, or corporate projects that impact the clinical aspects of the service(s) under leadership purview.
• Assist with the evaluation and management of vendor and partnership opportunities.
• Collaborate with the leadership accountable for applicable vendors supporting business area needs.
• Oversee or participate in internal committees relevant to work responsibilities; may represent the department through presentations and/or active participation in cross functional organizational committees
• Implement an integrated continuous quality improvement and change process to assure high quality care, innovation, customer satisfaction and contribution to financial performance of the Program or Operations.
• Responsible for the oversight, compliance, and execution of all regulatory or accreditation activities and processes including the accuracy and compliance of the State, Federal, and other accrediting bodies (i.e. ERISA, DOI, NCQA, CMS).
• Serve as primary contact for compliance and regulatory body audits related to the services under leadership purview.
• Ensure programs and operational changes are communicated to all appropriate internal and external stakeholders in accordance with policies and regulations.

Benefits

• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

What This Job Offers

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