Behavioral Health Care Manager I

Elevance Health; Seven Hills (OH); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Short and long term disability

401(k) +match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

Elevance Health is seeking a Behavioral Health Care Manager I to oversee facility-based and outpatient psychiatric and substance use treatment benefits through telephonic or written review.

The role emphasizes UM guidelines and contract compliance, with in-person training as required. Current licensure in an appropriate field is required; Ohio licensure is highly preferred if licensed locally.

Qualifications

• Requires MA/MS in social work/counseling or nursing degree or equivalent.
• Active, unrestricted clinical license in applicable state(s).
• Experience with facility-based/outpatient behavioral health treatment.

Responsibilities

• Manage psychiatric and substance abuse treatment benefits via telephonic or written review.
• Assess member needs to ensure access to medically necessary behavioral care.
• Coordinate UM approvals and promote quality member outcomes.

Skills

Crisis call center experience

Ohio licensure preferred

Spanish bilingual preferred

Licensed to practice independently

Case management / utilization mgmt

Education

MA/MS in social work/counseling or related field or nursing degree

Job description

Behavioral Health Care Manager I

Virtual: This role enables associates to workvirtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.Alternate locations may be considered if candidatesresidewithin a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unlessaccommodationis granted as required by law.

Work Hours: Monday – Friday 11AM – 8PM, covers holidays

The Behavioral Health Care Manager I responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review.

How you will make an impact

Primary duties may include, but are not limited to:

• Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract.
• Refers cases to Peer Reviewers as appropriate.
• Performs psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes to optimize member health benefits and to promote effective use of health benefits and community resources.

Minimum Requirements:

• Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing and minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience which would provide an equivalent background.
• Current active unrestricted license, such as RN LCSW LMSW LMHC LPC 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 required.
• 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.

Preferred Skills, Capabilities and Experiences:

• Crisis call center experience is preferred
• Licensed in Ohio is highly preferred
• Bilingual in Spanish is preferred
• Licensed to practice independently is highly preferred
• Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills

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.

• merit increases
• paid holidays
• Paid Time Off
• 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
• financial education resources

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.

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 and Influenza. 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.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.