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Director l Medical Management - Utilization and Case Management (FHPS) (PS26509)Location: United StatesNewRequisition #: PS26509Your Talent. Our Vision. At National Government Services (NGS) , an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country,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.Location : This position will be office-based in an Anthem / Amerigroup office.The Director l Medical Management is responsible for leading multiple teams of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Primary duties may include, but are not limited to:
Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.
Areas managed may include utilization management, case management, disease management, retrospective claims review and demand management.
May also manage appeals for services denied.
Management responsibilities include hiring, training, coaching, counseling, and evaluating performance of direct and indirect reports.
Requires 5-7 years acute care clinical experience or any combination of education and experience, which would provide an equivalent background.
Current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States preferred.
Prior management experience required.
Requires:
5-7 years of experience in a health care environment including management experience or of any combination of education and experience, which would provide an equivalent background.
Current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States required.
Prior management experience required.
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Experienced manager who has managed more than one function with clinical oversight for a large segment of the business strongly preferred.
Minimum of 5 years’ experience in an administrative role in a medical management and case management department of a health plan strongly preferred.
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.
Vacancy expired!