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Behavioral Health Care Mgr / U...

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Job Summary

Company
Anthem
Location
Louisville, KY
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS1441

Behavioral Health Care Mgr / Utilization Review - Field Work, Louisville, KY (PS1441)

About the Job

Description

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 benefits companies and a Fortune Top 50 Company.

Location: Work from home when not visiting provider facilities in the state of Kentucky. Travel will be often be in the Louisville, Elizabethtown, and Georgetown, Kentucky areas, but may require travel to other areas of the state. Candidates should reside near Louisville, KY.

The Behavioral Health Care Manager l 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.
  • Travels to provider facilities in, and around, the Louisville area, to complete clinical utilization management reviews for medical necessity.
  • 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.

Qualifications

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.
  • Current active unrestricted license as an RN, LCSW, LMHC, LPC, LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in the State of Kentucky required.
  • Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
  • Must be able to travel regularly (day travel) in and around the Louisville, KY area and on occasion throughout the state of Kentucky.

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 and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

 

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