Vacancy caducado!
Description SHIFT: Day JobSCHEDULE: Full-timeYour 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 benefits companies and a Fortune Top 50 Company.This is position is office-based and can be located at any Anthem Office within the US. Responsible for the same duties as the Director I Medical Management In addition to managing an environment of larger, more significant scope, complexity and change in multiple operations centers. Primary duties may include, but are not limited to:
Oversees care management operations across a wide range of products, clients and states including meetings with key major account clients.
Leads and participates in cross functional corporate teams which design and implement new care management programs that may impact multiple lines of business.
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.
May direct multiple medical management programs including utilization management, case management, demand management and disease management programs, which typically support multiple lines of business.
May also manage appeals for services denied.
Staff size is typically large, located in multiple sites and/or states and utilizes multiple systems.
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 matrix Care Management partners (such as IM or PE&C) to resolve issues or find solutions.
Manages budget and special projects.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications
Requires a BS in nursing or related health care field;
8 years of experience in a health care environment (i.e. acute care) including management experience; or any combination of education and experience, which would provide an equivalent background.
MS or advanced degree in a clinical nursing specialty, business or healthcare-related field preferred.
Current active unrestricted RN license to practice as a health professional within the scope of practice required.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Clinical and operations experience preferred.
UM/CM experience a plus.
Managed care experience a plus
May require working during non-standard business hours.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc 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.REQNUMBER: PS35220
Vacancy caducado!