What are the responsibilities and job description for the Managed Care Coordinator (US) position at Anthem?
Managed Care Coordinator
Location : WFH BUT WITH SOME TRAVEL TO CLIENTS OR PATIENT 30%
Must reside in the state of Virginia. Candidates are regionally based and should be prepared to travel as clinically necessary .
Monday-Friday 8am-5pm EST
A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
The Managed Care Coordinator is responsible for performing telephonic or face-to-face history and program assessments using a tool with pre-defined questions for the identification, evaluation, coordination, and management of member's program needs.
How you will make an impact:
Responsible for performing case management telephonically and/or by home visits within the scope of licensure for members with behavioral health and substance abuse or substance abuse disorder needs.
Primary duties may include but are not limited to: Uses appropriate screening criteria knowledge and clinical judgment to assess member needs.
Conducts assessments to identify individual needs and develops care plan to address objectives and goals as identified during assessment.
Monitors and evaluates effectiveness of care plan and modifies plan as needed.
Supports member access to appropriate quality and cost-effective care.
Coordinates with internal and external resources to meet identified needs of the members and collaborates with providers.
Minimum Requirements:
Requires BA/BS degree and a minimum of 1 year of experience working directly with people related to the specific program population or other related community-based organizations; or any combination of education and experience which would provide an equivalent background.
Specific education and years and type of experience may be required based upon state law and contract requirements.
Travel may be required.
Preferred Qualifications:
BA/BS degree field of study in health care related field preferred.
Experience in case management and telephonic and/or in person coaching with members with a broad range of complex psychiatric/substance abuse and/or medical disorders preferred.
QMHP certification or MA/MS in social work, counseling, or a related behavioral health field preferred.
Managed Care Network Adequacy Analyst
Virginia Department of Human Resource Management -
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