Therapy Manager

Anthem, Inc in Cerritos, CA

  • Type: Full Time
position filled
Therapy Manager **Location:** **Cerritos, California, United States** **New** **Requisition #:** PS32564 **Post Date:** 6 days ago Your Talent. Our Vision. **At CareMore** , a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it's a powerful combination. It's 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. CareMore is entering a new growth phase, as a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients and currently serve **nearly 200,000** patients in **multiple** states across Medicare, Medicaid, and commercial populations. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America's largest managed healthcare organizations. CareMore's **Health Networks, Primary Care+, Touch and CareMore@Home models drive** strategy, operations, and care delivery in our national markets (Arizona, California, Colorado, Connecticut, Iowa, Nevada, New York, Tennessee, Texas, Virginia and the District of Columbia), where CareMore builds and runs capitated primary care medical groups, at-risk health networks and upstream care delivery products in service of high-risk Medicaid, Medicare and commercial patients. Our comprehensive, **upstream** approach to **health is led by robust multidisciplinary teams of** extensivists (managing acute and post-acute episodes of care), primary care clinicians, behavioral health clinicians, care management & engagement specialists (including social workers, case managers and community health workers), and mobile home-based care teams. We continue to evolve our model to effectively engage and care for complex patients, **led by a** team of passionate, execution-minded leaders dedicated to this mission. You can learn more about CareMore's transformative approach to care here: + Des Moines Register - New Model: Insurers Hire Doctors + The Atlantic - The Quiet Healthcare Revolution + The New York Times - The High Price of Failing America's Costliest Patients Responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management (BH CM) or a combination of both functions (integrated model). May also be responsible for the Employee Assistance Program (EAP)/Resource Center (RC). Primary duties may include, but are not limited to: + Serves as a resource for medical management programs. + Identifies and recommends revisions to policies/procedures. + Ensures staff adheres to accreditation guidelines. + 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. **Responsibilities for BH UM may include:** + 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; + Leads development and maintenance of positive relationship with providers and works to ensure quality outcomes and cost effective care; 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. **Responsibilities for BH CM may include:** + Manages a team of licensed clinicians and non-clinical support staff engaged in telephonic outreach to members; + Oversees staff assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs; + Monitors and evaluates effectiveness of care plans; + Manages case consultation and education to customers and internal staff for efficient utilization of BH services; + Supports process improvement and quality assurance activities; + Ensures adherence to appropriate departmental policies, care management best practices, relevant clinical standards, and member contracts; + Facilitates collaboration across departments to ensure cost effective and quality member care. **Additional responsibilities for integrated BH UM and BH CM model include:** + Integrates the UM/CM functions to improve information flow and collaboration. + Responsibilities for EAP/Resource Center include: Managing a team of licensed clinicians and non-clinical support staff responsible for telephonic crisis intervention, substance abuse/biopsychosocial assessments, employer services (such as Management Consultations and Supervisory Referrals) and connecting members or providers with available resources (per BH benefits or EAP benefit plan) to optimize quality outcomes and cost effective care; + 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 EAP and BH Services; + Manages case consultation and education to customers and internal associates of effective utilization of BH and EAP services and leads development and maintenance of positive relationship with members, clients and providers; + Serves as a resource for direct reports, vendors, account management, implementation teams, privacy and compliance and infrastructure support teams. **LICENSURE REQUIREMENTS FOR ALL FUNCTIONS:** + Requires current, active, unrestricted license as an RN, LCSW (as applicable by state law and scope of practice), 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. + For Government business only: LAPC, LAMFT, and LMSW are also acceptable if allowed by applicable state laws and any other state or federal requirements that may apply; provided that the managers director has one of the types of licensure specified in the preceding sentence. **EDUCATION/EXPERIENCE REQUIREMENTS:** + Prior experience in Managed Care setting required. + Additional requirements for BH UM: 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. **Additional requirements for BH CM:** + 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; + Extensive experience in case management and telephonic coaching with members with a broad range of complex psychiatric/substance abuse and/or medical disorders; 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. + Certification as a Case Manager from the approved list of certifications is preferred. **Additional requirements for BH EAP/Resource Center:** + 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 EAP 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. + Certified Employee Assistance Professional (CEAP) is preferred. **Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc. magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.** </script>

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