BH Case Mgr II
DescriptionSHIFT: Day Job
Primary duties may include but are not limited to:
- Completes face-to-face visits with the member in the home, hospital, and other community settings, such as doctor's offices, treatment centers, etc. (Temporarily outreach is telephonic only due to the pandemic.)
- Responds to more complex cases 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.
- Monitors and evaluates effectiveness of care plan and modifies plan as needed.
- 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.
- Identifies members at high risk for complications and coordinates care in conjunction with the member and the health care team.
- Identifies members that would benefit from an alternative level of care or other waiver programs.
- Assists in problem-solving with providers and the health care team.
- Serves as a resource to other Case Managers.
- Participates in cross-functional teams projects and initiatives.
- Requires MS or MA in social work counseling or a related behavioral health field or a degree in nursing; 3- 4 years of clinical experience in social work counseling with broad range of experience with complex psychiatric, complex medical 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 as an RN, LCSW, LMHC, LPC (as allowed by applicable state laws), LMFT, LAPC, LAMFT, LMSW (as allowed by applicable state laws), or Clinical Psychologist to practice as a health professional within the scope of licensure in the applicable state is 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.
- Experience in health coaching and motivational interviewing techniques preferred.
- Experience working in a field based position.
Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.