Behavioral Health Care Manager I

Behavioral Health Care Manager I

The Behavioral Health Care Manager (UM) job is primarily a provider facing role although it does involve some member facing activities such as collecting information and using clinical knowledge and expertise to ensure our members are directed to the appropriate level of care. Responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review.

Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Schedule: Monday – Friday, 8:00 AM – 5:00 PM

How you will make an impact:

• Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract.
• Refers cases to Peer Reviewers as appropriate.
• Performs psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes to optimize member health benefits and to promote effective use of health benefits and community resources.

Minimum Requirements:

• Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience which would provide an equivalent background.
• Current active unrestricted license, such as RN LCSW LMSW LMHC LPC 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 required.
• Licensure is a requirement for this position.

Preferred Skills, Capabilities and Experiences:

• Previous case management and/or utilization management experience with complex psychiatric and substance use disorder cases preferred.
• Experience with higher levels of behavioral health care, including inpatient mental health, detoxification, residential, and facility-based services preferred.
• Strong clinical judgment, problem-solving, analytical, and oral/written communication skills.
• Ability to work in a fast-paced environment, quickly learn and apply clinical guidelines, and adapt to changing priorities, processes, and workflows.
• Self-motivated, proactive, and able to work independently in a virtual environment while effectively communicating with providers and members.
• Must reside in Pennsylvania within one of the following service counties: Crawford, Venango, Mercer, Butler, Lawrence, Westmoreland, Armstrong, Indiana, Washington, Beaver, or Fayette.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: MED > Licensed/Certified Behavioral Health Role