Anthem, Inc. Director I HCMS in Columbia, South Carolina
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.
We are hiring for a Director I HCMS for our Medicaid service line. 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.
Responsible for managing the Utilization and Care Management process 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:
Implements and manages health care management, utilization, cost, and quality objectives.
Identifies opportunities to improve the customer service and quality outcomes and ensures program compliance
Oversees the development and execution of medical and case management policies, procedures, and guidelines.
Assists in developing clinical management guidelines. Ensures medical management activities are contracted, reviewed and reported.
Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a BA/BS in a health care field
8 years of clinical experience, including prior management experience; or any combination of education and experience, which would provide an equivalent background.
RN, LCSW, or LPC preferred.
National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience preferred.
Masters in a health care field or MBA with Health Care concentration preferred.
Certified Case Manager preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
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.