Anthem, Inc. RN Director l Utilization Mgmt. / Case Mgmt in Lincoln, Nebraska
SHIFT: Day Job
WellCare Nebraska is now a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals. 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.
Director l Utilization Mgmt. / Case Mgmt. - Nebraska Medicaid
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
Location: Omaha, Nebraska or Lincoln, Nebraska. (Currently remote with return to office)
The Director l HCMS for Nebraska Medicaid is responsible for managing the utilization and care management process for one or more-member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members. Primary duties may include, but are not limited to:
Implements and manages health care management, utilization, cost, and quality objectives.
Ensures program compliance and identifies opportunities to improve the customer service and quality outcomes.
Oversees the development and execution of medical and case management policies, procedures, and guidelines; assists in developing clinical management guidelines.
Ensures medical management activities are contracted, reviewed and reported.
Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.
Analyze reports/data and make recommendations to improve quality and cost of care.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
BA/BS in a health care field; 8 years of clinical experience, including prior management experience; or any combination of education and experience, which would provide an equivalent background.
5 – 7 years Utilization Management and Case Management experience
Proficiency in Microsoft Office applications
Current, unrestricted RN license in the State of Nebraska
Population health managing social determinants of health
Experience with Nebraska Medicaid population within managed care industry
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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.