Job Description

We're seeking a Senior Episodic Care Manager to join our Behavioral Health Team! The Senior Episodic Care Manager - Behavioral Health Autism Services 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 Bring

• BCBA with at least 3 years experience in clinical work

• 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 BCBA license within the US and have started application for NC license.

What You’ll Get 

The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community 

• Work-life balance, flexibility, and the autonomy to do great work 

• Medical, dental, and vision coverage along with numerous health and wellness programs 

• Parental leave and support plus adoption and surrogacy assistance 

• Career development programs and tuition reimbursement for continued education 

• 401k match including an annual company contribution 

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.
 

$81,068.00 - $129,708.00

Skills

Clinical Decision Support (CDS), Clinical Evaluations, Clinical Experience, Clinical Support, Medical Review, Medication Management, Patient Advocacy, Patient Care Coordination, Patient Discharge Planning, Patient Education

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