Behavioral Health Care Manager I or II
DescriptionSHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., 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 at one of America's leading health care companies and a Fortune Top 50 Company.
BH Care Manager I or II - Location: Work at home in CA (Statewide). CA Licensure and residency is a requirement for this position.
***May be hired as a Behavioral Health Care Manager Level l, or Level ll depending upon the level of education, skills, and relevant experience.
Work hours will be 8 am - 5 pm EST or PST
Responsible for managing facility-based care with Psychiatric and Substance Abuse facility-based and outpatient benefits through telephonic or written review. Facility-based care includes Acute Inpatient, Detox, Residential, Partial Hospitalization, and Intensive Outpatient levels of care.
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 facility-based, psychiatric, and substance abuse initial reviews and assessment of care, and continued stay reviews to ensure coordination, of care, case planning, monitoring, and evaluating facility-based care to promote quality member outcomes, to optimize member health benefits, and to promote effective use of health benefits and community resources
• Will serve as a resource to other BH Care Managers.
• Assists with more complex cases, and may participate in inter and intradepartmental teams, projects, and initiatives.
• This Care manager job requires the candidate to be able to type very fast while they talk to the Utilization Review staff person on the phone and receive specific details about how a member (patient) is doing.
• Review information is either provided on the phone live or from their voicemail.
• Ability to work on multiple computer platforms simultaneously to manage caseload in addition to excellent typing skills
• Requires a Master’s degree in social work, counseling, or a degree in nursing; 3 years of clinical experience providing treatment to individuals with complex psychiatric and or substance use disorder diagnosis; or any combination of education and experience which would provide an equivalent background.
• Requires Current active unrestricted California license to practice as an RN LCSW LMFT or Clinical Psychologist within the scope of licensure in California. Licensure is a requirement for this position.
• Requires residency in California
• Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases
• Experience on multiple levels with computers
• Strong clinical background in substance use disorder preferred
• Ability to work on multiple computer platforms simultaneously to manage caseload in addition to excellent typing skills.
• Prior managed care experience
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.
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. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
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.