Anthem, Inc. Behavioral Health Case Manager II in Hampton, Virginia
SHIFT: Day Job
Behavioral Health Case Manager II 8:30a-5:30p | Mon - Friday Remote position, but in the field 60% of the time Reviewing applicants in Northern Virginia and Tidewater
Please note: The BH Case Mgr (CM) job progression is primarily member facing and involves complete clinical assessment. Whereas 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.
Be part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Build the possibilities. Make an extraordinary impact:
Responsible for performing case management telephonically and/or by home visits within the scope of licensure for members with behavioral health and substance abuse or substance abuse disorder needs. Subject matter expert in targeted clinical areas of expertise such as Eating Disorders (ED) Maternity Alcohol / Drug Autism Spectrum Disorders (ASD) etc. Also responsible for working with members admitted medically when appropriate. Face-to-face collaboration at hospitals will be a priority.
Build the possibilities. Make an extraordinary impact:
Responds to more complex cases, including BH members requiring hospital discharge support, and account specific requests.
Uses appropriate screening criteria knowledge and clinical judgment to assess member needs.
Conducts assessments to identify individual needs and develops specific care plan to address objectives and goals as identified during assessment. Discharge planning goals including assessing medication needs, transportation needs, and over-discharge appointment planning needs will be a priority.
Monitors and evaluates the effectiveness of care plan and modifies plan as needed. Identifies clinical and SDOH drivers impacting hospitalizations and ED usage.
Supports member access to appropriate quality and cost-effective care.
Coordinates with internal and external resources to meet identified needs of the members and collaborates with providers. Consults with Anthem Utilization Management (UM) as appropriate. Facilitating collaboration and coordination with the goal of reaching hospital UM staff/hospital discharge planners is a priority.
Serves as a resource to other BH Case Mgrs. Participates in cross-functional teams projects and initiatives.
Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 3 years of clinical experience in social work counseling with broad range of experience with complex 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 (as applicable by state law and scope of practice) LPC (as allowed by applicable state laws) LMFT to practice as a health professional within the scope of licensure in applicable states or territory of the United States required.
Previous experience in case management and telephonic and/or in person coaching with members with a broad range of complex psychiatric/substance abuse and/or medical disorders.
Managed care experience required.
For Government business only LAPC LAMFT (as allowed by applicable state laws) is also acceptable in addition to other licensure referenced above; and any other state or federal requirements that may apply.
Preferred Skills, Capabilities, and Experiences:
Experience in health coaching and motivational interviewing techniques preferred.
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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.