Job Description:
Location: Burkeville, VA
Description:
TEMP REMOTE - Behavioral Care Manager I - Richmond, VA Market
Job Summary:
- Previous utilization management experience, licensure requirement, prior experience working in a fast paced environment requiring the ability to multi-task and prioritize.
- Individual will have to be fully licensed in the state in which they reside with an unrestricted license. For this position the person has to be a master's level, licensed clinician or an RN (licenses accepted - LPC, LCSW, or LMSW).
- The preference is the individual be located within 1 hour of an anthem office. Hours will be standard hours between the hours of 8 am to 6 pm/EST; 40 hour work week.
Description:
- 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.
- Overview of role - Supporting clinical call queue where taking call from Providers to pre-cert members who need inpatient care. Also taking crisis calls from members or anyone that has access to number. There is no direct client/patient contact. Team will input clinical info into electronic health record.
- 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.
- 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 as an RN, LCSW, LMSW, LMHC, LPC, LBA (as allowed by applicable state laws), LMFT, or Clinical Psychologist, to practice as a health professional within the scope of licensure in applicable states or territory of the United States required.
- Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
- Previous utilization management experience, licensure requirement, prior experience working in a fast paced environment requiring the ability to multi-task and prioritize. Individual will have to be fully licensed in the state in which they reside with an unrestricted license. For this position the person has to be a master's level, licensed clinician or an RN (licenses accepted - LPC, LCSW, or LMSW).
- Clinician has to be fully licensed in the state in which they reside, live within commuting distance of one hour of an Anthem office.
Contact: mmabry@judge.com
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