Anthem, Inc. Behavioral Health Care Manager I - Utilization Mgt Team in Dallas, Texas
SHIFT: Day Job
Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s 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.
Behavioral Health Care Manager I - Utilization Mgt Team LOCATION: This is a remote position servicing our Medicaid members in Texas. Texas clinical license and residency is required. HOURS: 8:00 am-5:00 pm, Monday through Friday Responsible for managing facility-based care with Psychiatric and Substance Abuse facility-based and outpatient benefits through telephonic or written review. Facility-based care includes Acute Inpatient, Detox, Residential, Partial Hospitalization, and Intensive Outpatient levels of care. Primary duties may include, but are not limited to: • Uses appropriate screening criteria, knowledge, and clinical judgment to assess member needs to ensure access to medically necessary, quality behavioral healthcare in a cost-effective setting following UM Clinical Guidelines and contract. • Refers cases to Peer Reviewers as appropriate. • Performs facility-based, psychiatric and substance abuse initial reviews and assessment of care, and continued stay reviews to ensure coordination, of care, case planning, monitoring, and evaluating facility-based care to promote quality member outcomes, to optimize member health benefits, and to promote effective use of health benefits and community resources • 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. • This Care manager job requires the candidate to be able to type very fast while they talk to the Utilization Review staff person on the phone and receiving from them specific details about how a member (patient) is doing. • Review information is either provided on the phone live or from their voicemail. • Work on multiple computer platforms simultaneously to manage caseload in addition to excellent typing skills
Minimum Requirements: Requires MS or MA in social work counseling or a related behavioral health field or a degree in nursing; 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, such as RN LCSW LMHC LPC LBA (as allowed by applicable state laws) LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in Texas required. Licensure is a requirement for this position.
Preferred Qualifications: Experience in utilization management/case management, with a broad range of experience with complex psychiatric/substance abuse cases, is strongly preferred. Managed Care experience is preferred. Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Excellent typing skills and the ability to work on multiple computer platforms. Experience working with MS Outlook and Excel. You will receive training on Anthem-specific applications, however, you must be comfortable working on a laptop with web-based applications. If you are not computer savvy this may hinder your ability to be successful in this position.
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.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.