Pay Range:

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Why this job matters:
The Duals Special Needs Plan (DSNP), Behavioral Health Care Manager (BH CM) is responsible for assessing members’ behavioral health needs, coordinating care, and creating individualized treatment plans for DSNP members. All work is completed on a scheduled cadence to ensure timely assessment, follow‑up, and care coordination. Treatment plans are specific, measurable, and regularly updated based on the member’s progress. BH CMs use Motivational Interviewing and clinical skills to engage members and support progress toward their health care goals.

What you will do:

• Manage a specific group of members with a SUD d/x through the healthcare delivery system, including behavioral health and medical services, by assessing needs and identifying interventions to address clinical, psychosocial, and functional risk factors
• Conduct telephonic and face-to-face behavioral health and comprehensive assessments, including in-home and weekly community-based visits at identified locations (e.g., shelters, treatment programs, provider offices, and hospitals)
• Develop relationships and collaborate with SUD community resources
• Develop and implement patient centered care plans
• Facilitate communication between members, behavioral health providers, medical providers, and other stakeholders to coordinate care and implement action plans focused on improving the member’s total health, including behavioral health outcomes.
• Identify opportunities to positively impact claims expense trends across all lines of business or at the individual member level through effective medical and behavioral health care management interventions.
• Evaluate and monitor behavioral health–informed action plans by working collaboratively with members and providers; modify plans as clinically appropriate based on member progress, engagement, and changing needs.
• Monitor and evaluate patient services to ensure appropriate coordination of medical and behavioral health care. Collaborate with the Utilization Review process, including pre‑authorization, concurrent review, screening cases for quality‑of‑care concerns, and discharge planning related to behavioral health services.
• Promote member and provider satisfaction by demonstrating working knowledge of member benefits, including behavioral health benefits, health, disability, and other resources available to support the member.
• Provide continuity and consistency of care by building positive relationships with the member and family, behavioral health providers, physicians, care coordinators, and the health plan.
• Work collaboratively with the interdisciplinary care team and other partners to develop and implement solutions that support behavioral health integration and quality improvement. Identify barriers to effective care delivery and opportunities for process improvement, while exemplifying corporate values of accountability, collaboration, integrity, and respect.
• Participate in department initiatives, quality improvement activities, and projects related to behavioral health and care management. Perform other duties as assigned.

What you need to succeed:

• Active and unrestricted Rhode Island LMHC or LICSW (required)
• Must reside in Rhode Island (required)
• Minimum 3 years of experience in a medical, behavioral health, or managed care environment
• Demonstrated experience working with the Substance Use Disorder (SUD) population (required)
• Must obtain Certified Case Manager (CCM) certification within three years of employment*
• Knowledge of healthcare plans and benefits.
• Knowledge of utilization management and/or coordination of care
• Understanding of health care delivery system access points and services
• Ability to navigate the healthcare delivery system
• Knowledge of business process improvement techniques and strategies
• Excellent verbal, written communications and technical skills

Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia