Remote New

Senior Episodic Care Manager - Behavioral Health Autism Services

Blue Cross and Blue Shield of North Carolina
$81,068.00 - $129,708.00
parental leave, paid time off, tuition reimbursement, 401(k)
United States, North Carolina
Mar 20, 2026
Job Description We're seeking a Senior Episodic Care Manager to join our Behavioral Health Team! The Senior Episodic Care Manager - Behavioral Health Autism Services utilizes advanced knowledge and experience in utilization management and medical reviews to perform varied senior-level functions for the department. Drives operational efficiencies, works with internal and external partners for care coordination, and provides input to valuable Utilization Management (UM) initiatives that support the delivery of high quality and cost-effective care across the health care system. What You'll Do Support member care coordination and departmental goals by performing Perform clinical evaluation and review of various member services for prior authorization or transition of care needs as needed to meet departmental goals Act as a subject matter expert to support clinical UM staff as first point of contact with process, business, and/or clinical questions. Serve as point of contact for internal stakeholders to provide expertise on utilization management related to discharge planning, the review of sales documents and benefit booklets, and/or other project/initiative support. Apply significant expertise in discharge planning and utilization management to expedite the coordination of services and equipment and facilitate safe and effective discharge plans for our members. Provide precepting support and mentorship to new hires and/or those needing refresher assistance. Serve as co-trainer for in-services Create and maintain relevant desktop procedures or process documentation. Provide system and project testing support as needed. Support team effectiveness through management of UM queues and work assignments. May provide coverage for representation on projects in place of leadership as needed due to other priorities. What You Bring BCBA with at least 3 years experience in clinical work Additional direct experience in utilization management, with demonstrated success in the ECM role, meeting or exceeding metrics and quality goals. Proven expertise in UM functions, and processes and/or discharge planning. Must have a valid BCBA license within the US and have started application for NC license. WhatYou'llGet The opportunity to work at thecutting edgeof health care delivery with a teamthat'sdeeply invested in the community Work-life balance, flexibility, and the autonomy to dogreat work Medical, dental, and vision coverage along withnumeroushealth and wellness programs Parental leave and support plus adoption and surrogacyassistance Career development programs and tuition reimbursement for continued education 401k match including an annual company contribution Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. Based on annual corporate goal achievement and individual performance. $81,068.00 - $129,708.00 Skills Clinical Decision Support (CDS), Clinical Evaluations, Clinical Experience, Clinical Support, Medical Review, Medication Management, Patient Advocacy, Patient Care Coordination, Patient Discharge Planning, Patient Education _____________________________________________________________________ JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.