Behavioral Health Case Manager II

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Evaluates and reviews medical or behavioral eligibility concerning benefits and clinical standards.

• Utilizes clinical knowledge and administrative guidelines to process service requests.

• Implements health management program interventions.

• Assesses, plans, coordinates, monitors, and evaluates options and services for medical necessity.

• Advocates for quality and cost-effective outcomes.

• Offers telephonic support to members facing chronic conditions or high-risk pregnancies.

• Conducts thorough assessments and evaluations, including at-risk education.

• Engages members using motivational interviewing techniques and reflective listening.

• Identifies and participates in on-site evaluations.

• Acts as a member advocate through effective communication and education.

• Encourages participation in care management programs.

• Ensures precise documentation of clinical information.

• Contributes to data collection and input for the clinical information system.

⛳️ Requirements

• An Associate's degree in a relevant field.

• Four years of recent clinical experience in a specified specialty area (such as oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery).

• Four years of experience in utilization review, case management, or clinical roles; two of these years must be clinical experience.

• Proficient in word processing software.

• Familiarity with quality improvement processes and demonstrable experience in these activities.

• Understanding of contract language and its application.

• Capability to work independently, prioritize tasks effectively, and make informed decisions.

• Strong judgment skills.

• Proven customer service, organizational, and presentation abilities.

• Demonstrated proficiency in spelling, punctuation, and grammar.

• Effective oral and written communication skills.

• Ability to persuade, negotiate, or influence others.

• Strong analytical or critical thinking skills.

• Capacity to manage confidential or sensitive information with care.

• An active, unrestricted RN license from the United States and the state of hire, or an active compact multistate unrestricted RN license as per the Nurse Licensure Compact (NLC), or an active, unrestricted license as a social worker, counselor, or psychologist from the United States and the state of hire.

🏝️ Benefits

• Subsidized health plans.

• Dental and vision insurance coverage.

• 401(k) retirement savings plan with company matching.

• Life insurance coverage.

• Paid Time Off (PTO).

• On-site cafeterias and fitness centers at major locations.

• Educational assistance.

• Service recognition programs.

• National discounts for movies, theaters, zoos, theme parks, and more.