Anthem In. Case Management Jobs

Job Information

Anthem, Inc. Mgr Behavioral Health Services in Flushing, New York

Description

SHIFT: Day Job

SCHEDULE: Full-time

Beacon Health Options: Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, 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.

For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Location: REMOTE but must live in NY or NJ

Preferred Location: Greater New York City area.

Work Hours: 8:30AM - 5:00PM in the time zone where you reside.

Responsible for a combination of both functions Behavioral Health Utilization Management and Behavioral Health Case Management (integrated model).

  • Primary duties may include, but are not limited to:

  • Serves as a resource for medical management programs.

  • Identifies and recommends revisions to policies/procedures.

  • Ensures staff adheres to accreditation guidelines.

  • Supports quality improvement activities.

  • May assist with implementation of cost of care initiatives.

  • May attend meetings to review UM and/or CM process and discusses facility issues.

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

  • Responsibilities for BH UM may include:

  • Manages a team of licensed clinicians and non-clinical support staff responsible to ensure medical necessity and appropriateness of care for inpatient/outpatient BH services.

  • Ensures appropriate utilization of BH services through level of care determination, accurate interpretation/application of benefits, corporate medical policy and cost efficient, high quality care

  • Manages consultation with facilities and providers to discuss plan benefits and alternative services

  • Manages case consultation and education to customers and internal staff for efficient utilization of BH services;

  • Leads development and maintenance of positive relationship with providers and works to ensure quality outcomes and cost effective care

  • Assists in developing clinical guidelines and medical policies used in performing medical necessity reviews

  • Provides leadership in the development of new pilots and initiatives to improve care or lower cost of care.

Qualifications

  • LICENSURE REQUIREMENTS FOR ALL FUNCTIONS: Requires current, active, unrestricted license as an RN, LMSW, LCSW in New York State.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.

REQNUMBER: PS41908-New%20York

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