Blue Shield of CA
Sr. Manager, Case Management Nurse Management (Behavioral Health)
Blue Shield of CA, Cameron Park, California, United States,
Your Role
The Senior Manager Care Management - Behavioral Health will report to the Director of Behavioral Health Utilization Management and Care Management. The Behavioral Health Care Management team helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and programs.
Your Work
In this role, you will:
Manage all aspects of day-to-day operations of the Behavioral Health CM program, including adherence to regulatory compliance and direct oversight of performance quality.Assure compliance with appropriate regulations and oversee and assure that there are comprehensive quality processes and utilization management programs in place.Responsible for the fiscal management of the program, including implementing and managing the budget.Directs and oversees support, management, and mitigation of issues related to non-quantitative treatment limitations and support regulatory compliance.Manages all aspects of MHPAEA requirements, implementation, create, and maintain supporting documentation, manage audits and information related to MHPAEA compliance.Lead the development of goals for the department and planning efforts (budgets, operational plans, etc.).Plans, organizes, directs, and controls the Program. Responsible for the administrative functioning of the Program.Implements all program policies and procedures through the appropriate assignment of duties to the administrative staff.Establishes staffing requirements, directs recruitment, selection and when necessary disciplinary action within the Program.Provide training and information about care management requirements to the staff.Build and maintain key working relationships across BSC related to your assigned functional area; consult with operations on ad hoc inquiries and requests for guidance.Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards.
Your Knowledge and Experience
Current CA RN License. LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences.Advanced degree preferred commensurate with field.Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field.Requires at least ten (10) years of prior relevant experience.Three (3) years conducting Care Management for a health insurance plan or managed care environment preferred.Strong understanding of behavioral health care management.Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases.Requires 4 years of management experience which includes the supervision of clinical and professional staff, budgeting, program planning.Basic familiarity with accreditation bodies.Successful track record in building and maintaining positive cross-functional relationships.Aptitude for developing a quick understanding of people, processes, and technology.Excellent analytical, communication, written, time management, and organizational skills.Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative.Ability to identify problems and works towards problem resolution independently, seeking guidance as needed.
Pay Range:
The pay range for this role is: $136400.00 to $204600.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
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The Senior Manager Care Management - Behavioral Health will report to the Director of Behavioral Health Utilization Management and Care Management. The Behavioral Health Care Management team helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and programs.
Your Work
In this role, you will:
Manage all aspects of day-to-day operations of the Behavioral Health CM program, including adherence to regulatory compliance and direct oversight of performance quality.Assure compliance with appropriate regulations and oversee and assure that there are comprehensive quality processes and utilization management programs in place.Responsible for the fiscal management of the program, including implementing and managing the budget.Directs and oversees support, management, and mitigation of issues related to non-quantitative treatment limitations and support regulatory compliance.Manages all aspects of MHPAEA requirements, implementation, create, and maintain supporting documentation, manage audits and information related to MHPAEA compliance.Lead the development of goals for the department and planning efforts (budgets, operational plans, etc.).Plans, organizes, directs, and controls the Program. Responsible for the administrative functioning of the Program.Implements all program policies and procedures through the appropriate assignment of duties to the administrative staff.Establishes staffing requirements, directs recruitment, selection and when necessary disciplinary action within the Program.Provide training and information about care management requirements to the staff.Build and maintain key working relationships across BSC related to your assigned functional area; consult with operations on ad hoc inquiries and requests for guidance.Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards.
Your Knowledge and Experience
Current CA RN License. LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences.Advanced degree preferred commensurate with field.Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field.Requires at least ten (10) years of prior relevant experience.Three (3) years conducting Care Management for a health insurance plan or managed care environment preferred.Strong understanding of behavioral health care management.Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases.Requires 4 years of management experience which includes the supervision of clinical and professional staff, budgeting, program planning.Basic familiarity with accreditation bodies.Successful track record in building and maintaining positive cross-functional relationships.Aptitude for developing a quick understanding of people, processes, and technology.Excellent analytical, communication, written, time management, and organizational skills.Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative.Ability to identify problems and works towards problem resolution independently, seeking guidance as needed.
Pay Range:
The pay range for this role is: $136400.00 to $204600.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
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