Manager Behavioral Health Services

Anticipated End Date:

2025-08-05

Position Title:

Manager Behavioral Health Services

Job Description:

Shift: Monday – Friday; 8:00am – 5:00pm

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. 

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.

**This role’s primary focus is ABA utilization management**

The Manager Behavioral Health Services is responsible for Behavioral Health Utilization Management (BH UM).

How you will 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.

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 activities; 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 applicabl