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Anthem, Inc. Manager I/II Healthcare Management (Columbus, Ohio) in Columbus, Ohio

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.

We are hiring a Manager I or Manager II Healthcare Management to support the Ohio Medicaid plan. 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.

This position is currently remote due to COVID. Once we have resumed all standard operations, this position will require office presence in our Columbus, OH location.

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.

Qualifications

Minimum Requirements – Manager I

Requires BA/BS and minimum of 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.

Current active unrestricted RN or LCSW and any other state or federal requirements that may apply is required.

Minimum Requirements - Manager II

Requires BA/BS in a related Health/Nursing field and minimum of 6 years of experience as aligned to appropriate license which includes 3 years prior management experience; or any combination of education and experience, which would provide an equivalent background.

Current active unrestricted RN or LCSW and any other state or federal requirements that may apply is required.

Preferred Qualifications

Masters in related Health/Nursing field preferred.

Certified Case Manager Certification preferred.

Prior implementation experience strongly preferred.

OH Medicaid experience strongly preferred.

Case management experience preferred.

Managed care experience preferred.

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: PS53746

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