SHIFT: Day Job
Your Talent. Our Vision. At UniCare, a subsidiary of 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 healthcare.
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
LOCATION: This is a remote position servicing our Medicaid members in West Virginia. West Virginia residency is required.
HOURS: 8:00 am-5:00 pm, Monday through Friday
This is a Utilization Management position, which 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.
In this position, you are responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review. P
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.
- Optimizes member health benefits and promotes the effective use of health benefits and community resources.
- Requires MS/MA in social work counseling, a related behavioral health field, or an ADN in nursing.
- Current active unrestricted license as an LCSW, LMSW, LPC, LMFT, LMHC, RN, or clinical psychologist from the state of West Virginia is required.
- Minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment is required.
- Experience in utilization management/case management, with a broad range of experience with complex psychiatric/substance abuse cases, is strongly preferred.
- Experience in rehabilitation services is preferred.
- Managed Care experience is preferred.
- Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
- You must be competent in Microsoft Word, Excel, and Outlook.
To apply for this job please visit anthemcareers.ttcportals.com.