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Managed Care Coordinator (NoLic) Behavioral Health - (Remote from home) - Virginia (click to view areas) PS4091 in Virginia Beach, VA at Anthem, Inc.

Date Posted: 3/28/2018

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.

Location:  Positions available in Richmond area, Tidewater, NoVA, and Roanoke regions - Remote, work from home. Virginia residency required. Some local travel required.

The Managed Care Coordinator is responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract.

  • Responsible for performing telephonic or face-to-face history and program needs assessments using a tool with predefined questions for the identification, evaluation, coordination and management of member's program needs
  • Using tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high risk complications) and coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order to provide care coordination support.
  • The process does not involve clinical judgment.
  • Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of services.
  • Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, and physicians. Identifies members that would benefit from expanded services.

Job Requirements

  • Virginia residency required.
  • Requires a BA/BS (in a health related field preferred); minimum of 3 years of experience working directly with people related to Behavioral Health or related community based organizations; or any combination of education and experience, which would provide an equivalent background.
  • Knowledge of Medicaid, managed care, and/or long term care programs strongly preferred.
  • Experience working with community resource groups strongly preferred.
  • Occasional local travel required (mileage and tolls reimbursed).
  • Knowledge of ICD-10 codes, medical terminology and coordination of benefits 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 EOE. M/F/Disability/Veteran