Manager, Behavioral Health Services - NC Case Management

Anticipated End Date:

2025-07-16

Position Title:

Manager, Behavioral Health Services - NC Case Management

Job Description:

A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. 

Manager, Behavioral Health Services (CM)

Locations:

• NC-DURHAM, 1960 IVY CREEK BLVD
• NC-WINSTON-SALEM, 5650 UNIVERSITY PKWY

Hybrid: 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.

The Manager, Behavioral Health Services (CM) is responsible for the Behavioral Health Case Management team.

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 CM process and discusses facility issues.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
• 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.
• Integrates the CM functions to improve information flow and collaboration.
• 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.

Minimum Requirements:

• M.S. 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.
• Requires current, active, unrestricted license such as RN, LCSW (as applicable by state law and scope of practice), LMHC, LPC, LMSW, 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. 
• Prior experience in Managed Care setting required.

For Government business only: LAPC, and LAMFT are also acceptable if allowed by applicable state laws and any other state o