Skip to Main Content

Manager Behavioral Health Services PS20744

Anthem Winston-Salem, NC

  • Benefits Offered Vision, Medical, Life Insurance, 401k, Dental
  • Employment Type Full-Time

We can't accept applications here. YOU MUST APPLY directly through our website using the following URL.

https://careers.antheminc.com/jobs/manager-behavioral-health-services-ps20744-35890

Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, 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

This is a 24 hour/7 day a week center.

We service our members 24 hours/ 7 days per week.

Currently we are seeking candidates for full-time positions that will work shifts within operational hours, this may include nights, weekends, and holidays.

Location: New location in Greensboro/Winston Salem North Carolina.

Responsible for Behavioral Health Utilization Management (BH UM) and the 24/7 crisis call center.

Primary duties may include, but are not limited to:

  • Serves as a resource for medical management programs.

  • Identifies and recommends revisions to policies/procedures.

  • Ensures staff adheres to accreditation guidelines.

  • Supports quality improvement activities.

  • May assist with implementation of cost of care initiatives.

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

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

  • 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.

  • Manages a team of licensed clinicians and non-clinical support staff responsible for telephonic crisis intervention and connecting members or providers with available resources to optimize quality outcomes and cost effective care.

  • Supports quality improvement by identifying new business processes, recommending revisions to policies/procedures and providing quality control to ensure adherence to the appropriate medical policy, best practices, relevant clinical standards and contracts for an inbound and outbound 24/7 call center managing BH Services.

  • Manages case consultation and education to customers and internal associates of effective utilization of BH services and leads development and maintenance of positive relationship with members, clients and providers.

  • Serves as a resource for direct reports, vendors, account management, implementation teams, privacy and compliance and infrastructure support teams.

Licensure requirements:

Requires current, active, unrestricted license as an RN, LCSW (as applicable by state law and scope of practice), LPC, LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in North Carolina.
For Government business only: LAPC, LAMFT, and LMSW are also acceptable if allowed by applicable state laws and any other state or federal requirements that may apply; provided that the manager’s director has one of the types of licensure specified in the preceding sentence.

Education and Experience Requirements:
Prior experience in Managed Care setting required.
MS degree in social work, counseling, psychology or related behavioral health field or a degree in nursing.

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.
Prior crisis call center experience.

We can't accept applications here. YOU MUST APPLY directly through our website using the following URL.

https://careers.antheminc.com/jobs/manager-behavioral-health-services-ps20744-35890

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Anthem

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.

Address

Winston-Salem, NC
Winston-Salem, NC
USA
Posted: over a month ago