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Manager Behavioral Health Serv...

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Job Summary

Company
Anthem
Location
Eagan, MN
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS2991

Manager Behavioral Health Services - Licensed Utilization Management Manager Eagan, MN PS2991

About the Job

Description
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.

Manager Behavioral Health Services - Licensed Utilization Management Manager Eagan, MN PS2991

Requires active, unrestriced licensure in the state of Minnesota:
RN, LCSW, LMHC, LPC, LBA, LMFT, Clinical Psychologist, LAPC, LAMFT, or LMSW

Work Location: Eagan, Minnesota

Responsible for Behavioral Health Utilization Management (BH UM). Manages a team responsible for UM review and Pre- authorizations for BH Services.

Primary duties may include, but are not limited to:
* Serves as a resource for medical management programs.
* Identifies and recommends revisions to policies/procedures.
* Ensures staff adheres to accreditation guidelines.
* Supports quality improvement activities.
* May assist with implementation of cost of care initiatives.
* May attend meetings to review UM process and discusses facility issues.
* Hires, trains, coaches, counsels, and evaluates performance of direct reports.
* Manages a team of licensed clinicians and non-clinical support staff responsible to ensure medical necessity and appropriateness of care for inpatient/outpatient BH services.
* Ensures appropriate utilization of BH services through level of care determination, accurate interpretation/application of benefits, corporate medical policy and cost efficient, high quality care.
* Manages consultation with facilities and providers to discuss plan benefits and alternative services.
* Manages case consultation and education to customers and internal staff for efficient utilization of BH services.
* Leads development and maintenance of positive relationship with providers and works to ensure quality outcomes and cost effective care.
* Assists in developing clinical guidelines and medical policies used in performing medical necessity reviews.
* Provides leadership in the development of new pilots and initiatives to improve care or lower cost of care.
Qualifications
Licensure Requirements:
* Requires current, active, unrestricted license as an RN, LCSW (as applicable by state law and scope of practice), 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 is required.
* For Government business only: LAPC, LAMFT, and LMSW are also acceptable if allowed by applicable state laws and any other state or federal requirements that may apply; provided that the manager's director has one of the types of licensure specified in the preceding sentence. Minnesota Licensure is required.

Education/Experience Requirements:
* Prior experience in Managed Care setting required.
* MS degree in social work, counseling, psychology or related behavioral health field or a degree in nursing; five (5) years of clinical experience with facility-based and/or outpatient psychiatric and chemical dependency treatment, prior utilization management experience, and experience applying clinical and policy knowledge on the continuum of Behavioral Health treatment; or any combination of education and experience, which would provide an equivalent background.

Key Qualifications:
* Utilization Management Experience
* Experience working with Children/Adolescents and Adults.
* Community Mental Health experience; knowledge of state resources.
* Analytical Skills and Critical Thinking
* Leadership experience
* Project Management skills
* Proficient MS Office
* Excellent oral and written communication skills

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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