Anthem In. Case Management Jobs

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Anthem, Inc. Provider Clinical Liaison - North Carolina Medicaid in Des Moines, Iowa

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, 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 may be remote within NC and will be responsible for overseeing a designated region of NC. Home office location: 11000 Weston Parkway, Cary, NC. Candidates must reside in the state of NC or neighboring states. Currently, this position is remote due to COVID. Once we resume all standard operations, travel time for this position will be as indicated under the Requirements section.

The Provider Clinical Liaison supports primary care groups in Advanced Medical Home population health activities. This position serves a key role in Healthy Blue’s geographically organized provider support. The Clinical Liaison is responsible for managing quality and medical expense goal metrics for primary care groups by assisting in connecting high risk members and those having HEDIS gaps to their medical homes, to establish care plans that improve health outcomes.

Primary duties include:

  • Use Healthy Blue databases and tools, including risk adjustment tools to identify opportunities for improvement in quality and costs for members in assigned practices

  • Develop an operational plan for each medical practice to deploy office personnel and coordinate with Healthy Blue resources to optimize performance on targeted quality measures and to improve clinical and cost outcomes for members identified to have high clinical risk

  • Coordinate scheduling of high risk members and those having HEDIS gaps for appointments

  • Communicate with medical office personnel about identified gaps in care that will be apparent to the practitioner at the patient encounter

  • Meet with physicians and other clinical personnel to problem solve and develop engagement plans for high risk members

  • Work with practitioners and office staff to improve documentation of diagnoses, including specific manifestations, facilitate access of members to Healthy Blue case management, population health, and behavioral health programs as indicated, and help coordinate services provided by practice and Healthy Blue personnel

  • Serve as the subject matter expert for primary care practices on all Healthy Blue clinically focused program

  • Conduct periodic meetings with each practice to track progress towards implementing the project plan and attaining goals established in the engagement contract

  • Support the Healthy Blue Provider Collaboration Lead in organizing and implementing support to achieve targeted revenue, medical expense, and quality goals for the assigned region

  • Assures compliance to practice guideline, delegation and continuity and coordination of care standards

  • Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of results.

Qualifications

Requires:

  • BA/BS in Nursing

  • Minimum 5 years of clinical experience

  • Demonstrated commitment to clinical quality improvement

  • Unrestricted RN license in the state of North Carolina

  • This position requires field work, visiting providers, approximately 75% of the time.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

REQNUMBER: PS43677-US

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