at Anthem, Inc in Wilmington, Delaware, United States
DescriptionSHIFT: Evening Job
SCHEDULE: Full-timeYour 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 benefits companies and a Fortune Top 50 Company. May be hired in at level I/II depending on experience and manager discretion. BH Care Manager I/II (UM) is 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.
+ 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.
+ Current active unrestricted license such as RN LCSW LPC (as allowed by applicable state laws) or LMFT to practice as a health professional within the scope of licensure in State of Residence.
+ Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required.
+ Prior managed care experience preferred.
+ Behavioral Health background required (inpatient or outpatient).
+ UM experience preferred.
+ Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
+ Schedule is Monday-Friday, 9:00am-5:30pm PST which is 12:00pm-8:30pm EST.
+ Position is work from home; must live within a reasonable commute to Anthem office.Applicable to Colorado Applicants Only Annual Salary Range*: $58,320 – $78,300 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
- The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.