Care Manager Behavioral Health Utilization Management

Employer
Anthem
Location
Eagan, Minnesota
Posted
May 18, 2018
Closes
Jun 17, 2018
Ref
PS2783
Category
Healthcare
Job Type
Employee
Employment Status
Full Time

Your Talent. Our Vision. At Anthem, Inc., the Government Business Division is focused on serving Medicaid, Medicare and uninsured individuals. Our commitment and focus on government health programs is the foundation upon which we’re creating better care for our members, greater value for our customers and better health for our communities. Join us and together we will drive the future of health care.

 

Join one of the fastest growing businesses in a company with the largest and most successful Medicaid business in the nation. The associate in this position will be supporting members enrolled in the Minnesota Medicaid Program. 

 

Behavioral Health Care Manager Utilization Management 

Level I/II/III (Job Family) Eagan, MN PS2783

 

Work Location: Eagan, Minnesota

This is an office based position - Monday-Friday 8 a.m. - 5 p.m.

 

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 criteria  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.  

 

Level II:

• 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. 

 

Level III:

• Will serve as a resource to other BH Care Managers. 

• Assists with more complex cases  and will participate in inter and intradepartmental teams  projects and initiatives. 

• Will serve as an assistant to the BH Care Manager Ld in implementing identified operational processes. 

• Will develop expertise in specified areas of business needs to assist management with unit operations. 

• May act as lead in the lead’s absence. 

 

Please note: The BH Care Manager (UM) job progression is primarily a provider facing role although it may involve some member facing activities such as collecting information and using clinical knowledge and expertise to ensure our members are directed to the appropriate level of care. 

Level I:

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

• 3 years of 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. 

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

 

Level II:

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

• 3-4 years of 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. 

• 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.

 

Level III:

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

• 4-5 years of 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. 

• 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.

 

Key Qualifications:

• Utilization Management Experience

• Experience working with Children/Adolescents and Adults.

 Current active unrestricted license as an RN, LICSW,  LCSW,  LMSW,  LMHC,  LPC,  LBA (as allowed by applicable state laws),  LMFT,  or Clinical Psychologist  to practice as a health professional within the scope of licensure in the state of Minnesota required. 

• Managed Care experience.

• Community Mental Health experience; knowledge of state resources.

 

Note: This position may be filled at the BH Care Manager I, II or III level.  The manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.

 

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

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