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Behavioral Health Care Manager II
3 months ago
Location: This position will work a remote/hybrid model (remote and office). The candidate will be required to be onsite once a month or every other month. The ideal candidate will live within 50 miles or a 1-hour commute each way of our Seven Fields, PA Elevance Health Pulse Point office. Hours: Monday-Friday 8:00 am -5:00 pm Eastern Standard Time The Behavioral Health Care Manager II 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. How you will make an impact: 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 and clinical support staff. Assists with more complex cases and may participate in inter and intradepartmental teams projects and initiatives. Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required. 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 LMSW LMHC LPC LBA (as allowed by applicable state laws) LMFT in Pennsylvania 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.
