Location: Primarily work from home; will come onsite (Pulse Point) for onboarding, training, or as otherwise required by managers.
Shift: M-F; 8:30am-5:00pm
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.
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
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.
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.
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
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,
Preferred
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.
Experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment strongly preferred.
Certified Employee Assistance Professional (CEAP) is preferred.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $104,420 to $130,525
Locations: California
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 for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
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.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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 an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
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 elevancehealthjobssupport@elevancehealth.comfor assistance.
