Location: Hybrid; Within 50 miles of any Elevance Health Pulse Point location
Shift: Monday - Friday; 8:00am - 5:00pm ET
The Manager II Behavioral Health Services is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management (BH CM) or a combination of both functions (integrated model). May also be responsible for the Employee Assistance Program (EAP)/Resource Center (RC). Serves as a mentor to lower leveled managers and as a subject matter expert for other areas of the company and within the department. Develops and manages annual operating budget.
How you will make an impact:
Serves as a resource for medical management programs.
Identifies and recommends revisions to policies/procedures.
Ensures staff adheres to accreditation guidelines.
Supports quality improvement activities.
May assist with implementation of cost of care initiatives.
May attend meetings to review UM and/or CM process and discusses facility issues.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Responsibilities for BH UM may include: Manages a team of licensed clinicians and non-clinical support staff responsible to ensure medical necessity and appropriateness of care for inpatient/outpatient BH services; ensures appropriate utilization of BH services through level of care determination, accurate interpretation/application of benefits, corporate medical policy and cost efficient, high quality care; manages consultation with facilities and providers to discuss plan benefits and alternative services; manages case consultation and education to customers and internal staff for efficient utilization of BH services; leads development and maintenance of positive relationship with providers and works to ensure quality outcomes and cost effective care; assists in developing clinical guidelines and medical policies used in performing medical necessity reviews; provides leadership in the development of new pilots and initiatives to improve care or lower cost of care.
Responsibilities for BH CM may include: Manages a team of licensed clinicians and non-clinical support staff engaged in telephonic outreach to members; oversees staff assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs; monitors and evaluates effectiveness of care plans; manages case consultation and education to customers and internal staff for efficient utilization of BH services; supports process improvement and quality assurance activities; ensures adherence to appropriate departmental policies, care management best practices, relevant clinical standards, and member contracts; facilitates collaboration across departments to ensure cost effective and quality member care. Additional responsibilities for integrated
BH UM and BH CM model include: Integrates the UM/CM functions to improve information flow and collaboration.
Responsibilities for EAP/Resource Center include: Managing a team of licensed clinicians and non-clinical support staff responsible for telephonic crisis intervention, substance abuse/biopsychosocial assessments, employer services (such as Management Consultations and Supervisory Referrals) and connecting members or providers with available resources (per BH benefits or EAP benefit plan) to optimize quality outcomes and cost effective care; supports quality improvement by identifying new business processes, recommending revisions to policies/procedures and providing quality control to ensure adherence to the appropriate medical policy, best practices, relevant clinical standards and contracts for an inbound and outbound 24/7 call center managing EAP and BH Services; manages case consultation and education to customers and internal associates of effective utilization of BH and EAP services and leads development and maintenance of positive relationship with members, clients and providers; serves as a resource for direct reports, vendors, account management, implementation teams, privacy and compliance and infrastructure support teams.
LICENSURE REQUIREMENTS FOR ALL FUNCTIONS:
Requires current, active, unrestricted license such as RN, LCSW (as applicable by state law and scope of practice), LMHC, LPC, LBA (as allowed by applicable state laws), LMFT, LMSW or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States.
For Government business only: LAPC, and LAMFT are also acceptable if allowed by applicable state laws and any other state or federal requirements that may apply; provided that the managers director has one of the types of licensure specified in the preceding sentence.
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.
EDUCATION/EXPERIENCE REQUIREMENTS:
Prior experience in Managed Care setting required.
Additional requirements for BH UM:
MS in social work, counseling, psychology or related behavioral health field or a degree in nursing and minimum of 5 years of clinical experience with facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience, which includes a minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background.
Preferred skills, capabilities, and experiences:
Experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment strongly preferred.
Additional requirements for BH CM:
MS in social work, counseling, psychology or related behavioral health field or a degree in nursing and minimum of 5 years of clinical experience with facility-based and/or outpatient psychiatric and chemical dependency treatment and extensive experience in case management and telephonic coaching with members with a broad range of complex psychiatric/substance abuse and/or medical disorders, which includes minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background.
Preferred skills, capabilities, and experiences:
Experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment strongly preferred.
Certification as a Case Manager preferred.
Additional requirements for BH EAP/Resource Center:
MS in social work, counseling, psychology or related behavioral health field or a degree in nursing and minimum of 5 years of clinical experience with facility-based and/or outpatient psychiatric and chemical dependency treatment and prior EAP experience, which includes a minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background.
Preferred skills, capabilities, and experiences:
Experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment strongly preferred.
Certified Employee Assistance Professional (CEAP) is preferred.
