Care Manager II – Utilization Management

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🏄 California – Remote

🏄 California – Remote

💵 $79.9k - $119.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Manage psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review • Use screening criteria knowledge and clinical judgment to assess member needs and ensure access to medically necessary, quality behavioral healthcare in a cost-effective setting • Apply UM Clinical Guidelines and contract requirements • Refer cases to Peer Reviewers as appropriate • Perform psychiatric and substance abuse assessment coordination, implementation, case planning, monitoring, and evaluation • Promote quality member outcomes and optimize member health benefits • Promote effective use of health benefits and community resources • Serve as a resource to other Behavioral Health Care Managers • Assist with more complex cases • Participate in inter- and intradepartmental team projects and initiatives

🎯 Requirements

• MA/MS in social work, counseling, or a related behavioral health field, and minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment; or an equivalent combination of education and experience • Current, active, unrestricted license such as LCSW, LMSW, LMHC, LPC, LMFT, or Clinical Psychologist license required • Previous case management/utilization management experience with complex psychiatric/substance abuse cases required • Prior managed care experience • Strong oral, written, and interpersonal communication skills • Problem-solving skills • Facilitation skills • Analytical skills • California licensed clinician highly preferred • Ability to work Monday–Friday, 8:30 am–5:00 pm Pacific Standard Time • Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted • New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided

🏖️ Benefits

• Comprehensive benefits package • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) with match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Required in-person training sessions • Flexible virtual work arrangement