Anthem, Inc. Manager II, Utilization and Case Management in Seven Hills, 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.
We are hiring for 2 Managers in Healthcare Management: Utilization Management and Case Management. 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 a team of physical and/or behavioral health practitioners in the development, implementation, and coordination of a comprehensive integrated Medical Management program designed to manage health outcomes in a highly complex member populations with varying degrees of medical complexity and acuity.
Participates in case and/or utilization management execution/decision making for managed member populations.
Primary duties may include, but are not limited to:
Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan.
Ensures continued compliance with specific medical management standards.
Engages in the development process for medical and clinical management policy, procedures, and strategies.
Evaluates medical, mental health, and substance abuse services for cost containment, to include complex/specialized member populations.
Ensures program deliverables and compliance by monitoring established goals and implementing improvement strategies.
Takes the lead within assigned area on ensuring the unit is positioned and prepared to execute on quality initiatives and activities including clinical indicators reporting, focus studies, HEDIS reporting and adherence to National Committee for Quality Assurance (NCQA) standards.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a BA/BS in a related Health/Nursing field; 6 years of experience as aligned to appropriate license, including 3 years prior management experience; or any combination of education and experience, which would provide an equivalent background
Current active unrestricted RN, LCSW, LPC, LMHC or other accepted license (as allowed by applicable state laws); and any other state or federal requirements that may apply is required
Masters in related Health/Nursing field preferred
Certified Case Manager Certification preferred.
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.