Anthem, Inc. Substance Abuse Behavioral Health Care Manager II Utilization Management in Richmond, Virginia
SHIFT: 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.
Substance Abuse Behavioral Health Care Manager II Utilization Management Location: Remote, work at home. Licensure is a requirement for this position. Work hours will be 8 am - 5 pm EST or CST
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. • Work on multiple computer platforms simultaneously to manage caseload in addition to excellent typing skills
Minimum Requirements • 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 clinical license to practice as an RN LCSW LMFT LPC or Clinical Psychologist within the scope of licensure in state of residency. Licensure is a requirement for this position.
Preferred Qualifications • Previous experience in case management/utilization management with a broad range of experience with complex substance abuse cases • Experience on multiple levels with computers • Strong clinical background in substance use disorder strongly 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.
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 email@example.com for assistance.