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Behavioral Health Manager UM / CM (Manager Behavioral Health Svcs) Colorado Springs to West of Denver (139011) in Colorado Springs, CO at Anthem, Inc.

Date Posted: 4/2/2018

Job Snapshot

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. 

Manager Behavioral Health Services
  

Location: We have multiple positions open across the territory from Colorado Springs to just west of Denver. Some positions will work from our local office and others will work from home if there is no office but will be required to commute to our office in Colorado Springs or Denver as needed.

 

PURPOSE: Responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management (BH CM), or a combination of both functions (integrated model).  PRIMARY DUTIES MAY INCLUDE, BUT ARE NOT LIMITED TO:  

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

  • Ensures staff adheres to policies and procedures and accreditation guidelines.

  • Monitor utilization trends and implement trend mitigation strategies

  • Implement and execute cost of care initiatives.

  • Serves as a resource for medical management programs.

  • Supports quality improvement activities.

  • Identifies and recommends revisions to policies/procedures.

  • Attend meetings to review UM and/or CM process and discusses facility issues.

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.

  • Monitor utilization trends and implement trend mitigation strategies 

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.

Job Requirements

LICENSURE REQUIREMENTS FOR ALL FUNCTIONS:

 

Current, active, unrestricted license as an RN, LCSW (as applicable by Colorado state law and scope of practice), LMHC, LPC, LBA (as allowed by applicable Colorado state law), LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in the state of Colorado.   

 

EDUCATION/EXPERIENCE REQUIREMENTS:   

  • Prior experience in Managed Care setting required.

Additional requirements for BH UM:
  • MS degree in social work, counseling, psychology or related behavioral health field; 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.

Additional requirements for BH CM:
  • MS degree in social work, counseling, psychology or related behavioral health field; five (5) years of clinical experience with facility-based and/or outpatient psychiatric and chemical dependency  treatment; extensive experience in case management and telephonic coaching with members with a broad range of  complex psychiatric/substance abuse and/or medical disorders; 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. 

  • Certification as a Case Manager from the approved list of certifications is preferred.  

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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