Anthem, Inc. Behavioral Health Care Manager I/II in Las Vegas, Nevada
SHIFT: Day Job
May be hired in at level I/II depending on experience and manager discretion.*
BH Care Manager I/II (UM) is 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 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.
Requires MS or MA in social work counseling or a related behavioral health field or a degree in nursing; 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 such as RN LCSW LPC (as allowed by applicable state laws) or LMFT to practice as a health professional within the scope of licensure in State of Residence.
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required.
Prior managed care experience preferred.
Behavioral Health background required (inpatient or outpatient).
UM experience preferred.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Schedule is Monday-Friday, 9:00am-5:30pm PST which is 12:00pm-8:30pm EST.
Position is work from home; must live within a reasonable commute to Anthem office.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.