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Dir II 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_PS5259

Dir II 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 the development, implementation, and oversight of integrated Medical Management of more than one member population type with varying degrees of medical complexity. Oversees case and utilization management execution/decision making for managed member populations. Is accountable to plan executive or executive team member dependent on plan size/complexity and is involved in the development of the strategic vision, goals, and objectives for medical management. Serves as liaison to state regulatory agencies. Primary duties may include, but are not limited to:
  • Directs and provides leadership for designing, developing, and implementing integrated medical management program to meet the demographic and epidemiological needs of the populations serviced.
  • Partners with other health plan/corporate leaders to develop and deliver innovative care management services, root cause analyses and solutions to achieve quality outcomes.
  • Directs Healthcare Management Program including disease management, case management, and utilization management.
  • Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs.
  • Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.
  • Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications
  • Requires a BA/BS in a health care field; 10 years of clinical work experience, including prior management experience; or any combination of education and experience, which would provide an equivalent background. Previous experience with NCQA accreditation and HEDIS reporting required. RN, LCSW, or LPC 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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