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Job Summary

Company
Anthem
Location
Iselin, NJ
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS4151

UM Behavioral Health Care Manager I or II - Iselin NJ - PS4151

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.

BH Care Manager I or II - Iselin, NJ - PS4151

Work Location: This position will work from our Iselin, NJ office location.

Please note: This position may be filled at the BH Care Mgr I or II level. The hiring manager will determine the level based upon the selected applicant's skillset relative to the qualifications listed for this position.

This position 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.
  • 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.
Qualifications

BH Care Mgr. 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.
  • Current active unrestricted license as an RN, LCSW, LSW, 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 New Jersey required.
  • Previous experience in utilization management with a broad range of experience with complex psychiatric / substance abuse cases preferred.

BH Care Mgr. 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.
  • Current active unrestricted license as an RN, LCSW, LSW, 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 New Jersey required.
  • Previous experience in utilization management with a broad range of experience with complex psychiatric / substance abuse cases required.
  • Prior managed care experience required.

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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