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Description SHIFT: Night JobSCHEDULE: 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 healthcare.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: This is a remote position supporting our 24/7 after-hours groupHOURS: 5 pm - 5 am OR 8 pm - 8 am EST M-F. The schedule includes 3 weekends out of a 6-week schedule and holidays. There is a 15% shift differential for applicable hours.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:Level IUses 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.
Promote the effective use of health benefits and community resources.
Level IIUses 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 Minimum Requirements Level IRequires current active unrestricted license as an LCSW, LMSW, LPC, LMFT, LMHC, or RN to practice as a health professional within the scope of licensure from the state of MO.
Requires MS/MA in social work, counseling, or a related behavioral health field or a degree in nursing; 3 years clinical experience in social work counseling with a broad range of experience with complex psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience which would provide an equivalent background.
Preferred Qualifications:Experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment is strongly preferred.
Experience in utilization management with a broad range of experience with complex psychiatric/substance abuse cases is strongly preferred.
Managed Care experience is preferred.
Experience with rehabilitation services, community mental health resources, CSB (Community Service Board), or similar is preferred.
Minimum Requirements Level II:Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 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 such as RN LCSW LMSW 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 MO.
Licensure is a requirement for this position. However, for states that do not require licensure a Board Certified Behavioral Analyst (BCBA) is also acceptable if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff supervision.
Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required.
Prior managed care experience required.
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. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.REQNUMBER: PS60649
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