Behavioral Health Care Manager I

About This Role

This role manages psychiatric and substance abuse treatment health benefits through telephonic or written review for a leading health company. It involves assessing member needs, coordinating care, and promoting effective use of health benefits and community resources.

Responsibilities

• Manage psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review
• Use appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary behavioral healthcare
• Refer cases to Peer Reviewers as appropriate
• Perform psychiatric and substance abuse or substance abuse disorder assessment coordination, implementation, case planning, monitoring, and evaluation to promote quality member outcomes

Requirements

• MA/MS in social work, counseling, or a related behavioral health field or a degree in nursing
• Minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment
• Current active unrestricted license to practice as a health professional within the scope of licensure in applicable states or territory of the United States

Qualifications

• MA/MS in social work, counseling, or a related behavioral health field or a degree in nursing
• Minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment

Nice to Have

• Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases
• Bilingual in Spanish
• Licensed in North Carolina
• Residency in North Carolina

Benefits