Sr Episodic Care Manager - Behavioral Health

Job Description

Utilizes advanced knowledge and experience in utilization management and medical reviews to perform varied senior-level functions for the department. Drives operational efficiencies, works with internal and external partners for care coordination, and provides input to valuable Utilization Management (UM) initiatives that support the delivery of high quality and cost-effective care across the health care system.

What You'll Do

• Support member care coordination and departmental goals by performing Perform clinical evaluation and review of various member services for prior authorization or transition of care needs as needed to meet departmental goals 
• Act as a subject matter expert to support clinical UM staff as first point of contact with process, business, and/or clinical questions.
• Serve as point of contact for internal stakeholders to provide expertise on utilization management related to discharge planning, the review of sales documents and benefit booklets, and/or other project/initiative support.
• Apply significant expertise in discharge planning and utilization management to expedite the coordination of services and equipment and facilitate safe and effective discharge plans for our members.
• Provide precepting support and mentorship to new hires and/or those needing refresher assistance.
• Serve as co-trainer for in-services
• Create and maintain relevant desktop procedures or process documentation.
• Provide system and project testing support as needed.
• Support team effectiveness through management of UM queues and work assignments.
• May provide coverage for representation on projects in place of leadership as needed due to other priorities.

What You'll Bring (Hiring Requirements)

• RN or LCSW (with 3 years of clinical experience)
• For Behavioral Health specific roles, other applicable licensure may be considered (LCSW, LPC, etc) with a minimum of 3 years of clinical experience.
• Additional direct experience in utilization management, with demonstrated success in the ECM role, meeting or exceeding metrics and quality goals.
• Proven expertise in UM functions, and processes and/or discharge planning. 
• Must have a valid nursing license (or for Behavioral Health, other relevant clinical license) within the US and have started application for NC license.

Nice to Have

• Medicare and/or Medicaid experience

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets,  licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. 

*Based on annual corporate goal achievement and individual performance.
 

$69,000.00 - $124,200.00 Apply