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    BH Care Manager I - Raleigh, United States - Elevance Health

    Elevance Health
    Elevance Health Raleigh, United States

    2 weeks ago

    Default job background
    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:

    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.


    Minimum 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 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.


    Preferred Skills, Capabilities, and Experiences:
    Bilingual in Spanish.
    Previous utilization management experience highly desirable.
    Experience with taking crisis line calls strongly preferred.

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