Anthem, Inc Behavioral Health Care Manager I or II - PS12720 in Tucson, Arizona

Behavioral Health Care Manager I or II - PS12720

New

Location: United States

Field: Medical

Requisition #: PS12720

Post Date: 4 days ago

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Please note: this position can be filled at either the BH Care Manager Level I or BH Care Manager Level II depending on qualifications and experience and is at the discretion of the manager.**

Locations Considered:

Norfolk, VA Office

Nevada - Remote within the state

BH Care Manager I

Please note: The BH Care Manager (UM) job progression is primarily a provider facing role although it does involve some member facing activities such as collecting information and using clinical knowledge and expertise to ensure our members are directed to the appropriate level of care. Responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review.

Primary duties may include but are not limited to:

  • Uses appropriate screening criteria and medical necessity criteria for behavioral health impatient and outpatient levels of care.

  • Demonstrates knowledge and clinical judgment to assess member needs to ensure access to medically necessary, quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract.

  • Refers cases to Peer Reviewers as appropriate.

  • Performs psychiatric and substance abuse or substance abuse disorder assessment, coordination, implementation, case planning, monitoring and evaluating to promote quality member outcomes, to optimize member health benefits, and to promote effective use of health benefits and community resources.

BH Care Manager II

Please note: The BH Care Manager (UM) job progression is primarily a provider facing role although it does involve some member facing activities such as collecting information and using clinical knowledge and expertise to ensure our members are directed to the appropriate level of care. Responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review.

Primary duties may include but are not limited to:

  • Uses appropriate screening and medical necessity criteria for behavioral health impatient and outpatient levels of care.

  • Demonstrates knowledge and clinical judgment to assess member needs to ensure access to medically necessary, quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract.

  • Refers cases to Peer Reviewers as appropriate.

  • Performs psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes to optimize member health benefits and to promote effective use of health benefits and community resources.

  • Completes retro reviews as well as current/live reviews.

  • Will serve as a resource to other BH Care Managers.

  • Assists with more complex cases and may participate in inter and intradepartmental teams projects and initiatives.

BH Care Manager I

  • Requires MS or MA in social work counseling or a related behavioral health field.

  • 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment

  • Or any combination of education and experience which would provide an equivalent background.

  • Current active unrestricted license as an RN, LCSW, LMSW, LPC, LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States required.

  • Experience working with Microsoft Office(Outlook, Word and Excel)

  • Experience working with electronic databases, multiple PC's, data entry, and typing.

  • Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.

  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

  • Experience using Facets and Macess is preferred.

  • Bilingual preferred.

BH Care Manager II

  • Requires MS or MA in social work counseling or a related behavioral health field.

  • 3-4 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment

  • Or any combination of education and experience which would provide an equivalent background.

  • Current active unrestricted license as an RN, LCSW, LMSW, LPC, LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States required.

  • Experience working with Microsoft Office(Outlook, Word and Excel).

  • Experience working with electronic databases, multiple PC's, data entry, and typing.

  • Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required.

  • Prior managed care experience required.

  • Experience using Facets and Macess is preferred.

  • Bilingual preferred.

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