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Mgr Behavioral Health Services (UM) Las Vegas, NV PS23568

Anthem Las Vegas, NV
  • Expired: over a month ago. Applications are no longer accepted.
Veterans Wanted

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.

Manager, Behavioral Health Services UM

This position is located in Las Vegas, NV

The department is open from 8 AM EST to 8 PM EST, you must be able to work a flexible scheduled within the department hours.

Responsible for Behavioral Health Utilization Management (BH UM).
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.
Responsibilities for BH UM may include:
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.

LICENSURE REQUIREMENTS FOR ALL FUNCTIONS: Requires current, active, unrestricted license as an RN, LCSW,LMHC,LPC,LBA,LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in Nevada.
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.

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 An Equal Opportunity Employer/Disability/Veteran.



Las Vegas, NV