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Mgr. Behavioral Health Service...


Job Summary

Norfolk, VA
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Mgr. Behavioral Health Services - Tidewater Region, VA - PS4455

About the Job


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.

This position supports a team of clinicians in the Tidewater area. You must live in this area to be able to supervise, meet with, coach and counsel your team, however, you will receive the training and equipment to work from a home office. You must have a high speed internet connection.

The Mgr. Behavioral Health Services is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management (BH CM) or a combination of both functions (integrated model). May also be responsible for the Employee Assistance Program (EAP)/Resource Center (RC).

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 and/or CM process and discusses facility issues.

Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Responsibilities for BH UM may include: 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.

Responsibilities for BH CM may include: Manages a team of licensed clinicians and non-clinical support staff engaged in telephonic outreach to members; oversees staff assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs; monitors and evaluates effectiveness of care plans; manages case consultation and education to customers and internal staff for efficient utilization of BH services; supports process improvement and quality assurance activities; ensures adherence to appropriate departmental policies, care management best practices, relevant clinical standards, and member contracts; facilitates collaboration across departments to ensure cost effective and quality member care.

Additional responsibilities for integrated BH UM and BH CM model include: Integrates the UM/CM functions to improve information flow and collaboration. Responsibilities for EAP/Resource Center include: Managing a team of licensed clinicians and non-clinical support staff responsible for telephonic crisis intervention, substance abuse/biopsychosocial assessments, employer services (such as Management Consultations and Supervisory Referrals) and connecting members or providers with available resources (per BH benefits or EAP benefit plan) to optimize quality outcomes and cost effective care; supports quality improvement by identifying new business processes, recommending revisions to policies/procedures and providing quality control to ensure adherence to the appropriate medical policy, best practices, relevant clinical standards and contracts for an inbound and outbound 24/7 call center managing EAP and BH Services; manages case consultation and education to customers and internal associates of effective utilization of BH and EAP services and leads development and maintenance of positive relationship with members, clients and providers; serves as a resource for direct reports, vendors, account management, implementation teams, privacy and compliance and infrastructure support teams.


LICENSURE REQUIREMENTS FOR ALL FUNCTIONS: Requires current, active, unrestricted license as an RN, LCSW, LPC, etc. in the state of Virginia.

-Must have a wide range of experience with a variety of behavioral health inpatient and outpatient therapy, counseling, and community services and resources.

-Prior leadership/management experience a plus.

-Knowledge of Medicaid, managed care preferred.

-Case Management, Utilization Management experience preferred.

-CCM a plus.

-Computer literate: MS Office (Word, Outlook, Excel) Must be comfortable working with computers and web-based applications.

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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