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BEHAVIORAL HEALTH CARE MANAGER I - UTILIZATION MGT TEAM
Location: San Antonio, TX Job Family: Medical Req #:
PS51518-San%20Antonio-San%20Antonio Date Posted: May 24, 2021
SHIFT: Day Job
Your Talent. Our Vision. At Amerigroup, a proud member of the
Anthem, Inc. family of companies focused on serving Medicaid,
Medicare and uninsured individuals, its a powerful combination. Its
the foundation upon which were 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
This is an exceptional opportunity to do innovative work that
means more to you and those we serve.
BH Care Manager I Utilization Management Location: Remote, Must
reside in Texas Responsible for managing facility-based care with
Psychiatric and Substance Abuse facility-based and outpatient
benefits through telephonic or written review. Facility-based care
includes Acute Inpatient, Detox, Residential, Partial
Hospitalization, and Intensive Outpatient levels of care.
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 following
UM Clinical Guidelines and contract.
Refers cases to Peer Reviewers as appropriate.
Performs facility-based, psychiatric and substance abuse initial
reviews and assessment of care, and continued stay reviews to
ensure coordination, of care, case planning, monitoring, and
evaluating facility-based care 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.
This Care manager job requires the candidate to be able to type
very fast while they talk to the Utilization Review staff person on
the phone and receiving from them specific details about how a
member (patient) is doing.
Review information is either provided on the phone live or from
Ability to work on multiple computer platforms simultaneously to
manage caseload in addition to excellent typing skills
Requires a Masters degree in social work, counseling, or a
degree in nursing Requires 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.
Requires Current active unrestricted license to practice as an RN
LCSW LPC LMFT or Clinical Psychologist within the scope of
licensure in Texas Requires experience working on multiple computer
platforms simultaneously Requires residency in Texas must live
within 60 miles of an Anthem office Requires excellent typing
skills Preferred experience in case management or utilization
management Preferred experience in managed care
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 Worlds Most Admired Companies
among health insurers by Fortune magazine, and a 2020 Americas 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
Please be advised that Anthem only accepts resumes from agencies
that have a signed agreement with Anthem. Accordingly, Anthem is
not obligated to pay referral fees to any agency that is not a
party to an agreement with Anthem. Thus, any unsolicited resumes,
including those submitted to hiring managers, are deemed to be the
property of Anthem.