Build the Possibilities. Make an extraordinary impact:
Responsible for Behavioral Health Utilization Management (BH UM), Autism Spectrum Disorder Utilization Management (ASD UM), Behavioral Health Case Management (BH CM) or a combination of both functions (integrated model).
How you will make an impact:
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.
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 Applied Behavioral Analysis (ABA) services; 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.
Requires current, active, unrestricted license such as RN, LCSW (as applicable by state law and scope of practice), LMHC, LPC, MFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States.
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; 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. 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; 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. Certification as a Case Manager is preferred.
Experience with Autism Spectrum Disorders and Applied Behavioral Analysis (ABA) services.
For candidates working in person or remotely in the below locations, the salary* range for this specific position
Applicable to Colorado Applicants Only
Annual Salary Range*: $86,772 - $130,158
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
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 email@example.com for assistance.