Anthem, Inc. Director, Practitioner Management at CareMore in Cerritos, California
SHIFT: Day Job
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it’s a powerful combination. It’s the foundation upon which we’re creating greater 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.
This position can have some remote work opportunities. Some travel will be required.
The Director, Practitioner Management role is responsible for providing enterprise leadership to develop, implement and control all processes related to practitioner management.
Primary duties may include, but are not limited to:
• Oversees policies and procedures to ensure compliance with all regulatory requirements relating to Credentialing functions including updating & collecting all documents/CAQH profiles to PSV/Committee Approval (Anthem/Aspire), Facility Privileging/Credentialing, Collaborating Physician Contracting and Provider Assignments, Entity/PC & Provider Medicare/Medicaid enrollments and obtaining licenses for provider networks.
• Ensures accurate and timely information for the purposes of pre-credentialing, physician and provider agreements and licensure activities, data analysis and recommends changes to criteria and processes.
• Participates as the practitioner management expert for regulatory audits, RFP responses and any other business unit needs related to practitioner management processes.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a BA/BS in Business Administration, Health Science, Medical Records or related field; 7+ years of people management experience, 5+ years in a process management/improvement environment, 5+ years of practice management and/or credentialing oversight experience, prior experience with NCQA and/or URAC credentialing standards; or any combination of education and experience, which would provide an equivalent background. MBA/MHA preferred.
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 careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.