[Hiring] Behavioral Health Clinical Review Manager @BlueCross BlueShield of Tennessee

Role Description

Are you passionate about making a meaningful impact on the lives of individuals facing mental health challenges, while working behind the scenes? If so, Utilization Management might be the perfect fit for you! In this role, you’ll play a critical part in shaping care decisions and improving outcomes, all without direct, face-to-face interaction.

What You’ll Do

• Apply your knowledge of Behavioral Health and Withdrawal Management diagnoses.
• Navigate the continuum of care and levels of care for Behavioral Health and Withdrawal Management.
• Present cases confidently and effectively during clinical rounds.
• Work independently with minimal supervision.
• Excel in a fast-paced, dynamic environment.

Qualifications

• RN or Social Work license required.
• 3 years - Clinical behavioral health / substance use disorder experience required.
• 1 year - Must be knowledgeable about community care resources and levels of behavioral health care available.
• 3+ years of experience in Psychiatric and/or Substance Use treatment.
• Background in Behavioral Health settings (both inpatient and outpatient).
• Prior experience in Utilization Management or Managed Care.
• Strong communication and presentation skills.
• Ability to work autonomously and manage time effectively.
• Adaptability and resilience in a rapidly changing work environment.

Requirements

• Current, active unrestricted Tennessee license in Nursing (RN) or behavioral health field (Master's level or above) required.
• RN may hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
• Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
• Independent, sound decision-making and problem-solving skills.
• Excellent oral and written communication skills.
• Strong interpersonal and organizational skills.
• Strong analytical skills.
• Positive relationship building skills and ability to engage with diverse populations.
• Ability to quickly identify and prioritize member needs and provide structured and focused support and interventions.

Benefits

• This is more than a job; it’s an opportunity to make a lasting difference in people’s lives while leveraging your expertise in a collaborative, supportive setting.

Company Description

BCBST BlueCross BlueShield of Tennessee, Inc. is committed to recruiting, hiring, training, and promoting individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.