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.

Primary duties may include, but are not limited to:

• 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.
• 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
• 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;

Licensure Requirements :

• 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
• 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.
• 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,
• a minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background.
• Experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment strongly preferred.
• Experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment strongly preferred. Certified Employee Assistance Professional (CEAP) is preferred.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.elevancehealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.