Description
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).
Experience with Substance Use Disorder Treatment and the VA Medicaid Addiction and Recovery Treatment Benefit (ARTS) is highly preferred.
Must have current unrestricted license to practice in Virginia.
• 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.
Additional responsibilities for integrated BH UM and BH CM model include:
Integrates the UM/CM functions to improve information flow and collaboration.
Managing a team of licensed clinicians and non-clinical support staff responsible for care management, substance abuse/biopsychosocial assessments, and connecting members or providers with available resources (per BH benefits) to optimize quality outcomes and cost effective care; supports quality improvement by identifying new business processes; recommends revisions to policies/procedures and provides quality control to ensure adherence to the appropriate medical policy, best practices, relevant clinical standards and contracts; manages case consultation and education to customers and internal associates of effective utilization of BH and SUD services; 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 LCSW (as applicable by state law and scope of practice), LMHC, LPC, LMSW, 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.
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 manager's director has one of the types of licensures 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 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. Additional requirements for BH 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 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.
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. A Fortune 20 company with a longstanding history in the healthcare industry, 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 in certain patient/member-facing roles 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 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. 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.