**JR133557 Manager II Behavioral Health Services (Utilization Management for Behavior Analysis Services)** Responsible for Behavioral Health Utilization Management (BH UM). Serves as a mentor to lower leveled managers and as a subject matter expert for other areas of the company and within the department. Develops and manages annual operating budget. **Location:** This position will work remote and must live in Florida. **How will you make an impact:** + Serves as a resource for medical management programs. + Identifies and recommends revisions to policies/procedures. + Ensures staff adheres to accreditation guidelines. + Supports quality improvement activities. + May assist with implementation of cost of care initiatives. + May attend meetings to review UM and discusses facility issues. + Hires, trains, coaches, counsels, and evaluates performance of direct reports. + Manages a team of licensed clinicians and non-clinical support staff responsible to ensure medical necessity and appropriateness of care for inpatient/outpatient BH services; ensures appropriate utilization of BH services through level of care determination, accurate interpretation/application of benefits, corporate medical policy and cost-efficient, high quality care; manages consultation with facilities and providers to discuss plan benefits and alternative services; manages case consultation and education to customers and internal staff for efficient utilization of BH services; leads development and maintenance of positive relationship with providers and works to ensure quality outcomes and cost-effective care; assists in developing clinical guidelines and medical policies used in performing medical necessity reviews; provides leadership in the development of new pilots and initiatives to improve care or lower cost of care. + Candidate will be responsible for the oversight of the utilization management team. + Responsible for a team of clinicians who conduct medical necessity review for behavior analysis services. + Responsibilities include overseeing clinical rounds, coordinating with medical director to ensure program meets quality standards and partnering with the network team to improve QI and access to services. **LICENSURE REQUIREMENTS FOR ALL FUNCTIONS** : + LICENSURE REQUIREMENTS FOR ALL FUNCTIONS: Requires current, active, unrestricted license such as RN, LCSW (as applicable by state law and scope of practice), LMHC, LPC, LBA (as allowed by applicable state laws), LMFT, LMSW or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States. + For Government business only: LAPC, and LAMFT are also acceptable if allowed by applicable state laws and any other state or federal requirements that may apply; provided that the managers director has one of the types of licensure specified in the preceding sentence. + Licensure is a requirement for this position. However, for states that do not require licensure a Board-Certified Behavioral Analyst (BCBA) is also acceptable if all of the following criteria are met; performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff supervision. + EDUCATION/EXPERIENCE REQUIREMENTS: Prior experience in Managed Care setting required. Additional requirements for BH UM: MS in social work, counseling, psychology or related behavioral health field or a degree in nursing and minimum of 5 years of clinical experience with facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience, which includes a minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background. **Preferred Skills, Capabilities, and Experiences** + Experience with child and adolescent population + A minimum of 5 years clinical practice as a BCBA, BCBA-D or licensed psychologist + Current active unrestricted Board-Certified Behavioral Analyst (BCBA) certification and/or state licensure required (Florida). + Prior utilization management experience preferred. + Prior managed care experience preferred. + Prior leadership experience managing, hiring, and coaching a team. + Experience with Applied Behavioral Analysis/Behavioral Analysis (BA) comprehensive and focused treatment modalities. + Experience applying clinical and policy knowledge on the continuum of clinical services. + Candidate must reside in Florida Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.