Manager, Behavioral Health Case Management

This is a fully remote position, open to applicants in Alabama, +24 more states.

📋 Description

• Assist in formulating operational strategies and innovative solutions for areas under clinical oversight.

• Utilize competitive intelligence to inform strategic program and product development and management.

• Oversee operational performance across multiple integrated clinical functions spanning various lines of business.

• Initiate and manage service initiatives and programs aimed at promoting quality and cost-effective outcomes.

• Collaborate with both internal and external customers to provide an integrated care delivery model and a seamless member experience.

• Investigate escalated or high-profile cases, troubleshoot issues, and guide staff toward resolutions.

• Present analyzed cases that require high-level administrative approval or intervention.

• Establish and track performance, production, process, outcome, and financial metrics and goals.

• Manage or support departmental, divisional, and corporate projects that impact clinical services.

• Evaluate and manage vendor and partnership opportunities.

• Oversee or participate in relevant internal and cross-functional committees.

• Implement continuous quality improvement and change processes.

• Supervise regulatory and accreditation activities, ensuring compliance and execution.

• Serve as the primary contact for compliance and regulatory audits.

• Communicate programs and operational changes to both internal and external stakeholders.

⛳️ Requirements

• Bachelor’s degree with 8+ years of relevant experience.

• If no degree, at least 10 years of relevant experience is required.

• For roles specific to Behavioral Health, applicable licensure such as LMSW, LCSW, LPC, or LMFT will be considered.

• A valid NC license or multistate compact license is preferred.

• A minimum of 3 years of direct supervisory or leadership experience is preferred.

• Experience in population health, care management, clinical review or coding, or utilization management within a healthcare organization/system or health insurance is preferred.

• Knowledge of managed healthcare organizations, governmental regulations, and applicable state and federal laws.

• Experience with regulatory and accreditation activities, including ERISA, DOI, NCQA, and CMS.

• Capability to manage clinical and non-clinical teams and staff.

• Ability to establish and monitor operational, process, outcome, and financial metrics.

• Authorization to work in the United States is required.

🏝️ Benefits

• The chance to work at the forefront of healthcare delivery with a team that is deeply committed to the community.

• A work-life balance, flexibility, and the autonomy to excel in your work.

• Medical, dental, and vision coverage alongside various health and wellness programs.

• Parental leave support, along with adoption and surrogacy assistance.

• Career development programs and tuition reimbursement for ongoing education.

• 401k matching that includes an annual company contribution.

• Annual Incentive Bonus.

• Paid Time Off (PTO).

• Competitive health benefits and wellness programs.

• Reasonable accommodations available for applicants with disabilities.