Anthem, Inc. Medical Management Operations Manager in Pembroke Pines, Florida
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
The Medical Management Operations Manager is responsible for performing specialized functional and technical analyses for complex projects and systems, and devises/modified procedures to solve involved program issues. Provides technical guidance to the Healthcare Management teams (including both Corporate and Health Plan levels) during implementation and product development, the analysis and identification/development of functional specifications to improve these processes during assigned projects.
Primary duties may include, but are not limited to:
Serves as project lead for implementing medical management systems and related technologies and interfaces; coordinates upgrades and new software to support acquisitions and new products.
Conducts research and functional needs analyses for issues within the Healthcare Management Services areas (including both Corporate and Health Plan levels).
Identifies gaps and makes recommendations for changes to improve policies, procedures, programs and operations.
Coordinates data analysis needs for implementation and report specifications (both operational and regulatory).
Develops and executes tracking tools for reporting.
Conducts root cause and current state analysis and makes recommendations for process redesign and improvement as supported by new technologies.
Develops project plans and tracking multiple projects simultaneously.
Monitors project deliverables and progress through continuous communication with project members.
Supports and coordinates system related needs; provides technical support and performing tests on system modifications; compiles test plans and test results.
Provide support to staff during implementations and transition cycles.
Acts as functional lead for all system technology development as related to Healthcare Management Services (including both Corporate and Health Plan levels).
Requires a BA/BS in a related field and minimum of 7 years experience in related field, with at least 5 years of experience in healthcare management in a managed care setting and 3 years of leadership/management experience; or any combination of education and experience, which would provide an equivalent background.
Masters preferred. RN, LCSW, MSN, MPH, MPA, MSW or Certified Case Manager preferred.
Applicable to Colorado Applicants Only
Annual Salary Range*: $103,000 – $123,600
Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.
- The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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.