Manager, Behavioral Health Care Management

Your Role

The Manager Care Management–Behavioral Health will report to the Senior Manager Care Management – Behavioral Health.  The role of Manager, Care Management – Behavioral health will be critical to the success of Blue Shield of California and the Commercial BH Care Management department in realizing it’s goals and objectives.  This position will support all aspects of care management and care coordination of behavioral health membership for commercial lines of business. In this role you will be responsible for managing care management programs, optimizing patient outcomes, improving care delivery processes, and ensuring compliance with regulatory requirements. The Manager will supervise a team of Behavioral Health Case Managers while collaborating with healthcare providers, payers, and members to achieve optimal clinical outcomes. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Manage all aspects of day-to-day operations of the Behavioral Health CM program, including adherence to regulatory compliance and direct oversight of performance quality. 

• Be responsible for team, department or functional area results in terms of planning, cost in collaboration with Sr Manager
• Ensure workflow procedures and guidelines are clearly documented and communicated
• Interpret or initiate changes in guidelines/policies/procedures
• Support the development of goals for the department and planning efforts (budgets, operational plans, etc.).  
• Provide training and information about care management requirements to the staff. 

• Build and maintain key working relationships across BSC related to your assigned functional area; consult with operations on ad hoc inquiries and requests for guidance

• Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards

Your Knowledge and Experience

• Requires Clinically Licensed Behavioral Health Practitioner or Registered Nurse or with a current unrestricted CA license (LCSW, LMFT, LPCC, Licensed Psychologist, or Registered Nurse (RN) with Behavioral Health experience)

• Advanced degree commensurate with experience required

• Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements

• Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program manager.

• Three (3) years conducting Care Management for a health insurance plan or managed care environment preferred

• Comprehensive knowledge of case management, discharge planning, utilization management and community resources.  Strong supervisory, communication and negotiation skills.

• Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases 

• Basic familiarity with accreditation bodies

• Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative

• Ability to identify problems and works towards problem resolution independently, seeking guidance as needed