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Anthem, Inc. Mgr Behavioral Health Services in Cary, North Carolina


SHIFT: Day Job

SCHEDULE: Full-time

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 care companies and a Fortune Top 50 Company.

Manager, Behavioral Health Services Primary Location: Remote, must be located in North Carolina and have the ability to travel to the Winston Salem office as needed/required. This is a 24 hour/7 day a week center.
We service our members 24 hours/ 7 days per week.
Currently we are seeking candidates for full-time positions that will work shifts within operational hours, this may include nights, weekends, and holidays.
Responsible for Behavioral Health Utilization Management (BH UM) and the 24/7 crisis call center. Primary duties may include, but are not limited to: • 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. This team will also be responsible for telephonic crisis intervention and connecting members or providers with available resources to optimize quality outcomes and cost effective care. • Leads development and maintenance of positive relationship with providers and works to ensure quality outcomes and cost effective care. • Ensures staff adheres to accreditation guidelines. • Supports quality improvement by identifying new business processes, recommending revisions to policies/procedures and providing quality control to ensure adherence to the appropriate medical policy, best practices, relevant clinical standards and contracts for an inbound and outbound 24/7 call center managing BH Services. • Manages case consultation and education to customers and internal associates of effective utilization of BH services and leads development and maintenance of positive relationship with members, clients and providers. • 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. • Serves as a resource for medical management programs. • Identifies and recommends revisions to policies/procedures. • 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. • Serves as a resource for direct reports, vendors, account management, implementation teams, privacy and compliance and infrastructure support teams.


Licensure requirements: Requires current, active, unrestricted license as an RN, LCSW (as applicable by state law and scope of practice), LPC, LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in North Carolina.

Education and Experience Requirements: Prior experience leading and managing clinical teams is required Prior experience in Managed Care 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. Prior crisis call experience. Computer skills: You must have experience working with MS Word, Outlook and Excel, SharePoint. You will receive training on Anthem specific applications, however, you must be comfortable working on a laptop with web-based applications. If you are not computer savvy this may hinder your ability to be successful in this position.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.