Anthem In. Case Management Jobs

Job Information

Anthem, Inc. Manager II Medical Management in Hacienda Heights, California

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.

Responsible to manage a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Primary duties may include, but are not limited to:

This position is a remote/work from home: Must live within 60 miles of an Anthem California office.

  • Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.

  • Manages areas which may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.

  • Applies clinical knowledge to work with facilities and providers for care-coordination.

  • May also manage appeals for services denied.

  • Serves as mentor to lower leveled managers and as subject matter expert for other areas of the company and within the department.

  • Manages multiple functions requiring unique sets of knowledge or has significant fiscal accountability.

  • Develops and manages annual operating budget. Hires, trains, coaches, counsels, and evaluates performance of direct reports.

  • Participation in internal and external partner meetings to represent department activities

Qualifications

Requires:

  • Minimum of 5 years acute care clinical experience which includes a minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background.

  • Current active unrestricted RN license to practice as a health professional within the scope of licensure in California required.

  • BS preferred.

  • Must reside in California

  • Certification as a Case Manager from the approved list of certifications preferred

  • For URAC accredited areas the following applies:

  • Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills preferred.

  • If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.

  • Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.

  • Required to follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which the associate is employed. 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.

    REQNUMBER: PS58612

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