Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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 benefits companies and a Fortune Top 50 Company.
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This position must be on site in the Louisville, KY location
The Director of Behavioral Health must be a behavioral health clinician with managed care behavioral health clinical and operational program management experience. The Director has overall responsibility for the plan’s behavioral health programs including cost and quality of care members receive, management of health plan staff, oversight of corporate Government Business Division behavioral health functions that support Kentucky, oversight of compliance with the state contract and all applicable federal and state regulations, and externally representing Anthem at meetings with regulators and other stakeholders. The position requires in office presence as well as travel to external meetings. Company car is available for business travel.
Primary duties may include, but are not limited to:
* Ensures appropriate utilization and administration of EAP or Behavioral Health services.
* Directs assessments, provides appropriate referrals, and performs follow up to ensure the quality and appropriateness of services.
* Develops and maintains a positive relationship with providers, advocates and state partners and works to maintain quality outcomes, proper billing, and coordination of care.
* Leads and participates in cross functional corporate teams which design and implement new care/case/utilization management programs that may impact multiple lines of business and multiple states.
* Develops and implements process and program redesigns.
* Leads multiple teams of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources.
* Ensures adherence to all contract, regulatory and accreditation requirements.
* Develops short/long-term objectives and monitors processes and procedures to ensure consistency with the enterprise and compliance with state and federal regulations.
* Collaborates with Care Management partners to resolve issues or find solutions.
* Plan, develop, direct and oversight the Anthem Kentucky Medicaid Behavioral Health Program. Annually review the program for cost and quality effectiveness and for compliance with the state contract and applicable federal and state regulations. Develop, implement and oversight any required changes.
* Oversight and regular review of behavioral health cost and utilization trends.
* Drive case management results through oversight of the local manager and case management staff to assure care plans for members needing more complex case management services are clinically appropriate and cost effective while meeting all specific state contract requirements for each population type such as foster children, members with special health care needs, members with both behavioral and physical health needs.
* Drive utilization results through oversight of the Behavioral Health Utilization Management (UM) to assure clinical authorization and denials are appropriate and cost effective and comply with all state requirements.
* Oversight of the Kentucky Medicaid Behavioral Health Hot Line to assure members in crisis quickly get the help they need from local emergency providers, and follow-up care is timely provided.
* Represent Anthem and our Behavioral Health Program at state regulatory agency meetings, legislative meetings and public hearings. Coordinate and prepare presentations with Anthem’s government relations director.
* Represent Anthem and our Behavioral Health Program for all audits, internal and external, and be responsible for assuring identified deficiencies are remedied.
* Participate as a member of the health plan’s senior leadership team to help provide overall plan leadership.
* Manages budget and special projects.
* Hires, trains, coaches, counsels, and evaluates performance of direct reports.
* Requires a MS in a mental health field (i.e. social work, counseling) or related field (i.e. nursing); 10 years of clinical experience including case management and leadership experience; or any combination of education and experience, which would provide an equivalent background.
* Current unrestricted license for specific profession (i.e. LCSW, LCP, MFT, RN,) as required.
/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /
**Job** *Medical*
**Title:** *Director Behavioral Health Services - 121361*
**Location:** *KY-Louisville*
**Other Locations:** *KY-Lexington*
**Requisition ID:** *121361*