Anthem, Inc. BH Care Manager II in Somerville, Tennessee
SHIFT: Day Job
Your Talent. Our Vision. At Anthem Blue Cross, a proud member of the Anthem, Inc. family of companies, 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.
Behavioral Health Care Manager I or II LOCATION: Must have TN license and reside in TN; preferably within a commutable distance to an Anthem office
The BH Care Manager (UM) job 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 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 psychiatric and substance abuse utilization review management to monitor provider assessment, coordination, implementation, and evaluation services to promote quality member outcomes and effective use of health benefits.
Requires a Master’s degree in social work, counseling, or a degree in nursing and 3 years of clinical experience providing treatment to individuals with complex psychiatric and or substance use disorder diagnosis in an inpatient or outpatient setting; or any combination of education and experience which would provide an equivalent background.
Requires Current active unrestricted license to practice as an RN LCSW LPC LMFT LAPSW LMSW or Clinical Psychologist within the scope of licensure in Tennessee
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required.
Previous experience in behavioral health field required.
Prior managed care experience preferred.
Experience with Microsoft Office 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 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. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.