Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, its a powerful combination. Its the foundation upon which were 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.

BH Care Manager I or II Job Family Utilization Management
Location: Remote, Texas Must live within 60 miles of an Anthem office

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 receiving from them 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

Qualifications

Requires a Masters degree in social work, counseling, or a degree in nursing
Requires 3 years of clinical experience providing treatment to individuals with complex psychiatric and or substance use disorder diagnosis
Requires Current active unrestricted license to practice as an RN LCSW LPC LMFT or Clinical Psychologist within the scope of licensure in Texas
Requires experience working on multiple computer platforms simultaneously
Requires residency in Texas must live within 60 miles of an Anthem office
Requires excellent typing skills
Preferred experience in case management or utilization management, required for Level II
Preferred experience in managed care, required for Level II

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. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.