Mgr II HCMS, BH Utilization Management - Metairie, LA PS33654

Job Description

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 healthcare.

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. Location: This position is office-based in Metairie. Minimal travel to other offices may be required. Responsible for managing a team of behavioral health practitioners in the development, implementation, and coordination of a comprehensive integrated Medical Management program designed to manage health outcomes in a highly complex member populations with varying degrees of medical complexity and acuity. Participates in utilization management execution/decision making for managed member populations. Primary duties may include, but are not limited to :

• Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan.
• Ensures continued compliance with specific medical management standards.
• Engages in the development process for medical and clinical management policy, procedures, and strategies.
• Evaluates medical, mental health, and substance abuse services for cost containment, to include complex/specialized member populations.
• Ensures program deliverables and compliance by monitoring established goals and implementing improvement strategies.
• Takes the lead within assigned area on ensuring the unit is positioned and prepared to execute on quality initiatives and activities including clinical indicators reporting, focus studies,
• HEDIS reporting and adherence to National Committee for Quality Assurance (NCQA) standards.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

• Current active unrestricted LCSW, LMSW, LPC, LMHC, LMFT, RN or Clinical Psychologist, in the state of Louisiana, is required.
• Requires a BS in related area of Healthcare required; MS is preferred.
• 6 years of Behavioral Health experience, as aligned to appropriate license, is required.
• 3 years direct Management experience is required.
• 5 years of Utilization Management experience is required.
• National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience is preferred.
• Medicaid experience is preferred.
• Experience with implementation of cost of care initiatives is preferred.
• Proficiency in Microsoft applications, especially Excel, is required.

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 antheminc.com/careers. Equal Opportunity Employer/Disability/Veteran.