Anthem, Inc. BH Care Manager I in Fresno, California
SHIFT: Day 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 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 group
HOURS: 5 pm - 5 am OR 8 pm - 8 am EST M-F. Weekend hours will be 8am-8pm Sat-Sun. 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:
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.
Promote the effective use of health benefits and community resources.
Minimum Requirements Level I
Requires current active unrestricted license as an LCSW, LMSW, LPC, LMFT, LMHC, or RN to practice as a health professional within the scope of licensure in applicable state(s) required
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.
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.
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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. 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. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.