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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.Location: Prefer candidates located near an Anthem officeJob Summary:Responsible for strategic planning and oversight of enterprise health care management (HCM) programs for all CSBD and GBD lines of business. Provides centralized medical management support functions, overall program governance and/or program delivery, and infrastructure for the health plans, regions, and clinical program teams. Primary duties may include, but are not limited to:
May be responsible for all or some of the following.
Responsible for strategic planning and execution of clinical program activities that span all lines of business in support of clinical operations and delivery of services.
Responsible for governance, delivery and/or infrastructure for enterprise wide clinical and non-clinical programs.
Delivers root cause analysis and solutions for improved Case Management/Disease Management processes and outcomes.
Delivers quality, high touch, customer responsive, and cost effective care.
Leads care delivery teams providing integrated solutions including behavioral health, wellness, and pharmacy.
Develops and implements standardized, consistent CM, DM tools to support health plans achieving accreditation.
Ensures execution and delivery of large scale initiatives including cost-of-care projects, new market and market expansions/implementation for HCM, infrastructure maintenance and enhancements, and program support.
Serves as clinical consultant in provider collaboration initiatives and directs medical management system design supporting bidirectional provider/health plan communication.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications
Requires a BA/BS in related field.
15 years clinical experience
Prior management experience.
Any combination of education and experience, which would provide an equivalent background.
Current unrestricted RN license in applicable state(s) required.
Case management and/or disease management experience.
MA/MS 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/VeteranREQNUMBER: PS36826
Vacancy expired!