- 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.
- 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 LMHC LPC (as allowed by applicable state laws) LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in North Carolina .
- Licensure is a requirement for this position. However, for states that do not require licensure a Board-Certified Behavioral Analyst (BCBA) is also acceptable if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff supervision.
- Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
- For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
- Bilingual in Spanish.
- Previous utilization management experience highly desirable.
- Experience with taking crisis line calls strongly preferred.
-
care manager
3 weeks ago
BrightSpring Health Services Winston-Salem, United States· CARE MANAGER · Job Locations · US-NC-WINSTON SALEM · ID · Line of Business · ResCare Community Living · Position Type · Full-Time · Pay Min · USD $22.00/Hr. · Pay Max · USD $26.00/Hr. · Our Company · ResCare Community Living · Overview · Work in conjunction with diverse clini ...
-
Home care service for person between 85
2 weeks ago
beBee Handyman Gary, MN, United States FreelanceI am in need of an in-home caregiver for an elderly person in Gary, MN with the following characteristics:Who is the service for? · Dependent elderly person · What type of conditions does the person have? · No known conditions or illnesses · What is the age range of the person? · ...
-
Manager Care Management
1 day ago
UNC Health Care Chapel Hill, United StatesDescription · Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve. · Join our dynamic seasoned pediatric team as an on-site manager at our UNC Chapel Hill campus, whe ...
-
Manager, Care Delivery Services
3 days ago
Blue Cross and Blue Shield of North Carolina Chapel Hill, United StatesJob Description · Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is seeking a Manager to join our growing Care Delivery Services Team We are looking for a driven and entrepreneurial individual that is excited by a role that involves executing a strategic vision for ...
-
TASC Care Manager Orange County
2 days ago
Coastal Horizons Center Chapel Hill, United StatesJob Title: TASC Care Manager Location: Orange County, NCHours: 40 hours/week, Full Time, M-F, ExemptCoastal Horizons Center, Inc. seeks a qualified Care Management professional for our TASC (Treatment Accountability for Safer Communities) Justice Services Intervention Program. We ...
-
Registered Nurse
1 week ago
Atrium Health Winston-Salem, NC, United StatesAtrium Health is seeking a Registered Nurse (RN) Orthopedic Surgery for a nursing job in Winston-Salem, North Carolina. · Job Description & Requirements · Specialty: Orthopedic Surgery · Discipline: RN · Duration: Ongoing · 36 hours per week · Shift: 12 hours · Employment Type: S ...
-
Case Manager Registered Nurse
5 days ago
Novant Health external-icims San Francisco, United States PermanentOverview · Relocation Bonus available up to $7,500Schedule: Fri/Sat/Sun or Sat/Sun/Mon 7:00 AM - 7:30 PM, Full-Time · Department: Case Management - supporting Neuro ICU, General Surgery, Neuroscience · Location: Forsyth Medical Center - Winston Salem, NC · The RN Case Manager ser ...
-
Novant Health Hanes, United StatesOverview · The Employer Solutions Registered Nurse is responsible for providing occupational health and corporate health nursing services to the corporate client employee population as indicated by policies and procedures, assessment, planning intervention and evaluation of care ...
-
Physical Therapist Baylor, Home Health
2 days ago
CenterWell Home Health Winston Salem, United StatesBecome a part of our caring community and help us put health first · As a Home Health Physical Therapist, you will: · Plan and administer prescribed skilled physical therapy treatment and training for patients suffering from various injuries, illnesses and functional disabilities ...
-
Registered Nurse, Adult Acute Care
2 days ago
Novant Health Hanes, United StatesOverview · Sign-on bonus available up to $30,000 and Relocation up to $7,500Schedule: 7pm-7am, Night Shift, Full-time · Department: Adult acute care unit specializing in tele/adult care and geriatric patient care · Location: Forsyth Medical Center - Winston-Salem, NC · Remarkable ...
-
Registered Nurse, RN
2 days ago
Novant Health Hanes, United States PermanentOverview · Sign-on bonus available up to $15,000 and Relocation up to $7,500Schedule: 7:00 PM -7:00 AM, Night shift, Part-time (24 hours). NO CALL This unit self-schedules. · Department: Pulmonary Progressive Care- Adult Acute Care · Location: Forsyth Medical Center, Winston Sale ...
-
Vascular Access Therapy Registered Nurse, RN
2 days ago
Novant Health external-icims Winston Salem, NC, United States PermanentOverview · We are actively hiring a Registered Nurse to work part-time on our Vascular Access Therapy team at Forsyth Medical Center in Winston-Salem, NC We strongly emphasize diversity and inclusion throughout our organization and invite applicants from all backgrounds to applyS ...
-
Registered Nurse, RN
16 hours ago
Novant Health external-icims Winston Salem, United StatesOverview · Schedule : 7pm - 7am, PRN · Department : Adult Acute Care · Location : Forsyth Medical Center - Winston Salem, NC · 4th General Telemetry operates as a fast-paced medical-telemetry unit, delivering exceptional care to patients with a range of medical diagnoses. Our dev ...
-
Registered Nurse, RN
2 days ago
Novant Health Hanes, United StatesOverview · Sign-on bonus available up to $30,000 and Relocation up to $7,500Schedule:7:00pm - 7:00am, Full-Time, 36 hours · Department: General Surgery - Adult Acute Care · Location: Forsyth Medical Center - Winston Salem, NC · Unit description: General Surgery is an inpatient A ...
-
Registered Nurse, Adult Acute Care
1 week ago
Novant Health external-icims Winston-Salem, North Carolina, United StatesOverview · Sign-on bonus $30,000 and Relocation up to $7,500Schedule: 7pm-7am, Night Shift, Full-time · Department: Adult Acute Care unit specializing in tele/adult care · Location: Forsyth Medical Center - Winston-Salem, NC · Remarkable Care. Remarkable Careers. · Why become a R ...
-
Registered Nurse, RN-Patient Placement
2 weeks ago
Novant Health external-icims Winston-Salem, United StatesOverviewSchedule: PRN · Department: Patient Placement · Location: Forsyth Medical Center · Remarkable Care. Remarkable Careers. · Why become a Registered Nurse at Novant Health?Clinical Ladder Program to help you advance your nursing career. · Recognized by Forbes as one of Amer ...
-
Registered Nurse
2 days ago
Novant Health Hanes, United States Part timeOverview · Sign-on bonus available up to $7,500 and Relocation up to $7,500 · ****Exciting News Come be apart of our NEW Critical Care Neuro/ Neuroscience and Surgical Intensive Care Unit**** · Schedule: 7p-7a, Night Shift-Part Time · Department: Critical Care Neuro · Location: ...
-
Registered Nurse, RN
2 days ago
Novant Health Hanes, United States Part timeOverview · Sign-on bonus available up to $15,000 and Relocation up to $7,500Schedule: 7pm-7am, Part-Time Night Shift (24 hours) · Department: 2nd General GI/Adult Acute Care · Location: Forsyth Medical Center - Winston-Salem, NC · 2nd GI is a newly remodeled 36 bed acute care uni ...
-
Registered Nurse Ambulatory Specialty Lead
1 week ago
Novant Health Hanes, United StatesOverview · Wound Care Experience is Not Required. · Expansion of Knowledge with Hypberbaric Medicine · Novant Health is looking for a RN Ambulatory Spec Lead responsible for assisting Providers by preparing patients for medical exam, assessment, and telephone triage. In partners ...
-
Registered Nurse
2 days ago
Novant Health Hanes, United States Full timeOverview · Sign-on bonus available up to $15,000 and Relocation up to $7,500 · • Schedule: 7a-7p, dayshift-Full Time · • Department: Cardiac Telemetry · • Location: Forsyth Medical Center, Winston-Salem, NC · Patient population in this unit includes those with chest pain, pacemak ...
BH Care Manager I - Winston-Salem, United States - Elevance Health
Description
A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
This is an individual contributor role and the person in this role must reside and live preferably within 50 miles of an Elevance Health North Carolina office location.
Work schedule: 1st week – 4x10 hour weekdays, 2nd week – 3x12 days to include weekends and holidays, and starting at 5 pm or 10 pm EST.
The BH Care Manager I 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:
Minimum Requirements:
Preferred Skills, Capabilities, and Experiences:
