Manager Behavioral Health Services

Manager Behavioral Health Services

Responsible for overseeing Behavioral Health Utilization Management (BH UM), this position supports the Medicaid line of business.

Location: Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within 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, unless an accommodation is granted as required by law.

How will you make an impact:

• 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.

Minimum requirements:

• Requires current, active, unrestricted license such as LCSW (as applicable by state law and scope of practice), LMHC, LPC, LMSW (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.

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; 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.

Preferred Skills, Capabilities, and Experiences:

• Leadership and prior management experience.
• Experience in managed care.
• Candidates from all states are welcome, but they must reside within commuting distance of a Pulse Point office location where we have an office to be considered.
• Proficiency in MS Office and data reporting.

Job Level: Manager

Workshift: 1st Shift (United States of America)

Job Family: MED > Licensed/Certified Behavioral Health Role

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.

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.

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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. 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.