BH Care Manager I or II for Anthem Inc in Texas
Some responsibilities include:
Description
This is a work at home position supporting the Texas Health Plan of Amerigroup. You must live in Texas and be licensed in the state of Texas. You will receive all necessary equipment for a home office (laptop, printer, shredder, file cabinet, etc.)
Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s 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.
Please note: The BH Care Manager (UM) job progression is primarily a provider facing role although it does involve some member facing activities such as collecting information and using clinical knowledge and expertise to ensure our members are directed to the appropriate level of care. Whereas the BH Case Mgr (CM) job progression is primarily member facing and involves complete clinical assessment.
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, and to promote effective use of health benefits and community resources.
Qualifications
This position may be hired as a BH Care Manager I or II depending upon the skills, education and experience of the chosen candidate.
Requires MS or MA in social work, counseling, nursing or a related behavioral health field; 3 years 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 in Texas as an RN, LCSW, LMSW, LMHC, LPC, LBA (as allowed by applicable state laws), LMFT, or Clinical Psychologist, to practice as a health professional is required.
-Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
-Medicaid/managed care experience preferred.
-Computer skills: MS Word, Outlook, Excel
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