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Posted: Friday, February 2, 2018 9:42 PM

*This is a PT, salaried, bi-weekly pay, work from home position.*
*Hours are 8:00am-5:00pm.*
*You will work 2 full days one week and 3 full days the following week, within the 2-week pay period.*
*You are supporting the West NY Health Plan and must have an active, unrestricted NY clinical license (i.e. RN, LCSW, LMHC, etc.).*
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.
This clinical individual is part of a team that reviews IP and OP prior authorization requests for the WNY (Buffalo) Health Plan, in compliance with NCQA and NY State DOH regulatory requirements including adherence to turnaround time limits, member and provider notification and quality documentation. The*BH Care Manager II*is 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.
-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.
Requires MS or MA in social work counselingora related behavioral health fieldora degree in nursing; minimum of 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.
-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 NY required. RN license preferred.
-Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required.
-Prior managed care experience preferred.
-Computer skills: MS Office (Word, Outlook, Excel)
-Knowledge of Facets, Care Compass a plus.
You must be comfortable working on a computer using web-based applications, with the ability to update excel spreadsheets and work with multiple screens to obtain necessary information.
You will be given the training and equipment needed for a home office. You must have a high speed internet connection.
Anthem, Inc. is ranked as one of America s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.
**Job** *Medical*
Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
**Title:** *PT (Part-time) BH (Behavioral Health) Care Manager II - Utilization Mgmt - Remote - Buffalo, NY - PS1049*
**Location:** *nevada-Henderson*
**Requisition ID:** *PS1049*
Associated topics: assistant gm, captain, fire captain, fire marshal, manager, police chief, police commander, sergeant, shift lead, supervisor


• Location: Henderson, Las Vegas

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