Anthem, Inc. Clinical Manager I HCMS - Bilingual (preferred), RN in Cerritos, California
SHIFT: Day Job
Your 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 care companies and a Fortune Top 50 Company.
Location: Any Anthem office location, Pacific time hours are preferrerd but not required.
Responsible for managing a team of physical and/or behavioral health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services for one or more member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members.
Primary duties may include, but are not limited to:
Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions.
Coordinates service delivery to include member assessment of physical and psychological factors.
Partners with providers to establish short and long term goals that meet the member's needs, functional abilities, and referral sources requirements.
Identifies members with potential for high risk complications.
Reviews benefit systems and cost benefit analysis.
Evaluates medical, mental health and substance abuse service for cost containment.
Supports program compliance and assists in identifying opportunities to improve the customer service and quality outcomes.
Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a BA/BS; 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.
Current active unrestricted RN license is required.
1 year of experience in a leadership role required.
Bilingual is preferred.
MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred.
Certified Case Manager Certification preferred.
Experience and demonstrated success in recognizing/developing talent and nurturing a team environment which results in open collaboration, strong business results and improved experiences.
Experience managing projects.
Strong proficiency with Microsoft Office Suite.
Experience with Visio, Avaya Proactive Contact and CMS a plus. Successful candidates should have the following qualities:
Kindness, compassion, empathy and a profound desire to help people
Ability to build relationships and influence others
Motivate and encourage teams, while providing guidance and driving quality and superior customer service
Excellent verbal and written communication skills
Adaptability and flexibility
Accountability and execution oriented
Curious/challenges the status quo
Analytical and problem solving skills
Creativity and critical thinking skills
Quick and continuous learning style
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.