Anthem, Inc. Staff VP Behavioral Health Clinical Ops in Denver, Colorado
SHIFT: Day Job
Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, 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.
For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon 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.
Staff VP Behavioral Health Clinical Ops
Location: Any Anthem or Beacon office preferred, however, for the right candidate (with leadership approval) open to considering candidates across the US living near any major metropolitan area not located within commuting distance to an Anthem office.*
Responsible for delivering clinically sound utilization management and clinical programs for Behavioral Health. Accountable for strategy and operational performance for utilization management (UM) and case management (CM) for behavioral health enterprise wide. Primary duties may include, but are not limited to:
Oversees centralized UM & CM function, which is delivered at a regional market level.
Develops and manages strategies to optimize utilization results, provides service performance, and ensures consistency and compliance with the enterprise and state and federal regulations. Leads a team that delivers UM & CM operations and is responsive to regional leadership and stakeholders to ensure tight collaboration between the department and client-facing teams.
Accountable for all incoming UM & CM requests, for all prior authorization and continued stay reviews, and for discharge documentation, discharge planning, aftercare, follow-up after hospitalizations, and case management programs.
Ensures BH clinical operations leadership build strong relationships with the Regional Leads across the company, as the day-to-day touchpoints for the regions. In collaboration with Finance, provides thought leadership and validates UM & CM target-setting for Beacon’s risk and ASO accounts.
Creates and maintains close partnerships with regional Market Presidents and stakeholders who have P&L responsibility and will look to clinical management performance as a key driver of the success of the P&L.
Participates in governance forums to track the overall medical management performance and the P&L of each region.
Champions a dynamic growth culture by driving revenue, profitability and initiatives.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires BA/BS in a clinical field, such as nursing, social work or psychology; 15 years progressively responsible management and senior leadership experience in healthcare and managed care industry; or any combination of education and experience, which would provide an equivalent background. Current, valid, unrestricted clinical license (RN, LCSW, MFT, LPCC, PhD or PsyD) required or BSN and must practice within scope of licensure. MA/MS degree such as MBA or MPH in a clinical field preferred.
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 careers.antheminc.com. 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.