- 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.
- 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 LPC LBA (as allowed by applicable state laws) LMFT or Clinical Psychologist 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. 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 required.
- Prior managed care experience required.
- Extensive experience working with patients with a substance use disorder strongly preferred.
- Strong utilization review experience within a facility preferred. Note: this role will be interfacing with facility personnel not members.
- Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.
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Behavioral Health Care Manager II - Jefferson City, 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.
BH 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.
How will you make an impact:
**This position is a 100% remote position.
**Candidates must be within 50-miles of an Elevance office location **
**Mon-Friday 8 am -5:00 pm EST
Ideal candidate must be licensed in the state in which they reside.
Minimum Requirements:
Preferred Skills, Capabilities and Experiences:
