Manager II Behavioral Health Services
| Company | Elevance Health |
|---|---|
| Location | Palo Alto, CA, USA, Newport Beach, CA, USA, Canoga Park, Los Angeles, CA, USA, Walnut Creek, CA, USA |
| Salary | $98256 – $153792 |
| Type | Full-Time |
| Degrees | Master’s |
| Experience Level | Senior |
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, which includes a minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background.
- Requires current, active, unrestricted California license such as LCSW (as applicable by state law and scope of practice), LCSW LMFT LPCC, RN (as allowed by applicable state laws), or Clinical Psychologist such as Psy.D. Ph.D. to practice as a health professional within the scope of licensure in applicable states or territory of the United States.
Responsibilities
- 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.
- 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.
Preferred Qualifications
- Prior experience in Managed Care setting strongly preferred.
- Experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment strongly preferred.
- Experience managing a clinical team.