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Anthem, Inc Manager I Care Management - Remote (EST Hours Required) - PS22803 in Dearborn, Michigan

Manager I Care Management - Remote (EST Hours Required) - PS22803

Location: United States

New

Requisition #: PS22803

Post Date: 6 days ago

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 healthcare .

This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America's leading health benefits companies and a Fortune Top 50 Company.

The hours of operation for this team are 8am-8pm EST with some Saturdays (40 hours per week total).

This position will be supporting our new client business nationwide.

Responsible for managing a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources.

Primary duties may include, but are not limited to:

Assesses the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care. Oversees process improvement, quality assurance, and adherence to applicable medical policy, care management best practices, relevant clinical standards, and member contract.

Ensures prevention and health management program accreditation standards are achieved.

Participates in establishing strategic plans and objectives; aligning, developing, and implementing functional area policies and procedures to support strategic plans and objectives.

Participates in establishing and managing the annual budget productivity targets.

Hires, trains, coaches, counsels, and evaluates performance of direct reports.

This position will be supporting our new client business nationwide.

Qualifications:

  • Requires a BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in applicable state(s) required.

  • Certification as a Case Manager is preferred.

  • Previous related managerial experience highly preferred.

  • Some travel may be required (once a quarter).

For URAC accredited areas the following applies:

  • Requires a BA/BS; 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.

  • Current and active RN license required in applicable state(s).

  • Certification as a Case Manager from the approved list of certifications and a BS in a health or human services related field preferred.

  • Managers who have directly supervised the case management process for three or more years must hold a certification as a case manager and meet continuing education requirements to maintain licensure and certification.

Anthem, Inc. is ranked as one of America’sMost Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

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