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Dir I HCMS

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
Eagan, MN
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS5224

Dir I HCMS

About the Job

Description

Your Talent. Our Vision. At Anthem, Inc., the Government Business Division is focused on serving Medicaid, Medicare and uninsured individuals. Our commitment and focus on government health programs is the foundation upon which we're creating better care for our members, greater value for our customers and better health for our communities. Join us and together we will drive the future of health care.

Join one of the fastest growing businesses in a company with the largest and most successful Medicaid business in the nation. The associate in this position will be supporting members enrolled in the Minnesota Medicaid Program.

Position will be located in Eagan, Minnesota



Responsible for managing the Behavioral Health 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.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications
  • Requires a 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. RN, LCSW, or LPC preferred. National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience preferred. Masters in a health care field or MBA with Health Care concentration preferred.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.


 

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