Anthem Behavioral Health Care Manager I or II - Nationwide (128639 KT) in Atlanta, Georgia

Anthem, Inc.is one of the nation's leading health benefits companies and a Fortune Top 50 company. At Anthem, Inc., we are working together to transform health care with trusted and caring solutions.

Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine.

Please Note: This position may be filled at either the Behavioral Health Care Manager I or Behavioral Health Care Manager II will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.”

Behavioral Care Manager I

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 and medical necessity criteria for behavioral health inpatient and outpatient levels of care

  • Demonstrates 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.

    Behavioral Health Care Manager II

    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 and medical necessity criteria for behavioral health inpatient and outpatient levels of care.

  • Demonstrates 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.

  • 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

Locations for this position

  • This role will allow you to work anywhere in the US and work from home.

    • Hours *
  • The department is open Monday - Friday 8AM to 8 PM EST you must be able to work any shift during those hours.

Behavioral Care Manager I /Requires/

  • MS or MA in social work, counseling, nursing or a related behavioral health field;

  • 3 years’ 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.

  • RN, LCSW, LMSW, LMHC, LPC, LMFT, or Clinical Psychologist, to practice as a health professional within the scope of licensure in applicable states or territory of the United States required. Experience working with Microsoft Office (Outlook, Word, and Excel)

  • Experience working with electronic databases, multiple PC’s, data entry, and typing

  • Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.

  • Experience using Facets and Macess is preferred

Behavioral Care Manager II Requires

  • MS or MA in social work, counseling, nursing or a related behavioral health field;

  • 3-4 years’ 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.

  • RN, LCSW, LMSW, LMHC, LPC, LMFT, or Clinical Psychologist, to practice as a health professional within the scope of licensure in applicable states or territory of the United States required

  • Experience working with Microsoft Office (Outlook, Word, and Excel)

  • Experience working with electronic databases, multiple PC’s, data entry, and typing

  • Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required.

  • Prior managed care experience required

  • Experience using Facets and Macess is preferred.

/Anthem is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at// www.antheminc.com/careers //. EOE.M/F/Disability/Veteran./

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Job Medical

Title: Behavioral Health Care Manager I or II - Nationwide (128639 KT)

Location: GA-Atlanta

Requisition ID: 128639