Anthem, Inc. Dir II Healthcare Management - Ohio Implementation in Columbus, Ohio
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 benefits companies and a Fortune Top 50 Company.
This position will be supporting our Ohio Medicaid Business and will be overseeing the case management and utilization management teams. Expected to partner with Population Health organization. Responsible for the development, implementation, and oversight of integrated Medical Management of more than one member population type with varying degrees of medical complexity. Oversees case and utilization management execution/decision making for managed member populations. Is accountable to plan executive or executive team member dependent on plan size/complexity and is involved in the development of the strategic vision, goals, and objectives for medical management. Serves as liaison to state regulatory agencies.
Primary duties may include, but are not limited to:
Directs and provides leadership for designing, developing, and implementing integrated medical management programs to meet the demographic and epidemiological needs of the populations serviced.
Partners with other health plans/corporate leaders to develop and deliver innovative care management services, root cause analyses, and solutions to achieve quality outcomes.
Directs Healthcare Management Program including disease management, case management, and utilization management.
Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs.
Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.
Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.
Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
This position is currently remote due to COVID. Once we have resumed all standard operations, this position will require office presence in our Columbus, OH locations. Traveling to other office locations in the state and traveling to provider sites for meetings with providers and state Medicaid entities (ODM) required.
Requires a BA/BS in a health care field; 10 years of clinical work experience, including prior management experience; or any combination of education and experience, which would provide an equivalent background.
Previous experience with NCQA accreditation and HEDIS reporting required.
Current unrestricted RN license in the state of OH strongly preferred. LCSW, or LPC licensure will be considered.
Masters in a health care field or MBA with Health Care concentration preferred.
Medicare/Medicaid experience highly preferred.
Managed care experience preferred.
Must be able to travel locally (15%-20%) daytime travel.
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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.