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Manager, Oversight Compliance - Glendale, CA.- PS27649Location: United StatesNewRequisition #: PS27649Y our 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 healthcare .This
is an exceptional opportunity to do innovative work that means more to you and
those we serve atone
of America's leading health benefits companies and a Fortune Top 50 Company.Manager, Oversight Compliance- Glendale, CA- PS27649Summary: The Manager, Oversight Compliance is responsible for managing clinical auditors of delegated provider organization throughout the state of CA for multiple lines of business.Primary duties may include, but are not limited to:
Develops and manages favorable working partnerships and relationships with delegated entities, physicians, healthcare service providers, and internal customers to improve the delivery and quality of health care.
Manages annual and ad hoc delegation oversight audits, analyses of performance measures, reporting, and development of corrective action plans.
Leads intervention activities to enhance communication and educate.
Designs programs and strategies to assist delegated entities in meeting standards and improving quality outcomes.
Develops operations processes and ensures standardization of procedures and documentation.
Negotiates with delegated entities and internal constituents as needed.
Leads healthcare industry initiatives that involve the standardization and streamlining of regulatory oversight functions.
Provides support for litigation issues surrounding regulatory compliance.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications:
Requires a BS;
6 years of acute care, utilization management, quality management in a hospital or provider organization that was delegated for HMO services with 3 years of management experience and 3 years of experience in conducting oversight audits of delegated entities and/or ancillary providers; or any combination of education and experience, which would provide an equivalent background.
May require some travel 20%
Current unrestricted RN license in applicable state(s) required.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc 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!