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Manager Regional Case Manageme...

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Job Summary

Company
Anthem
Location
New York, NY
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS3487

Manager Regional Case Management Perf/Integration, New York, #PS3487

About the Job

Description

Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it's a powerful combination. It's the foundation upon which we're creating greater 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.
Responsible for managing quality, cost effective care using selective benefits and alternative services best suited for the member.

Responsible for the implementation and integration of new services/clients in the assigned region. Sets CareMore case management performance goals and metrics and serves as the operational lead.

Primary duties may include, but are not limited to:

  • Manages operational and oversight activities of the care management program including the development and implementation of metrics to monitor productivity, composition of program descriptions and development of workflows and job aids.
  • Leads regional care management activities and functions and ensures consistent delivery across all regional locations.
  • Manages quality improvement, cost containment, care management, and member and provider grievance resolution.
  • Develops and executes a performance strategy for the assigned region.
  • Serves as the subject matter expert and assists in the development and implementation of new programs and lines of business.
  • Acts as a liaison to Legal, Compliance, and Quality department on issues and supports audits and develops corrective action plans for assigned region.
  • Ensures care management services are coordinated and optimized to meet regional and department/company objectives.
  • Develops and manages annual operating budget.
  • Monitors and tracks performance, identifies areas for improvement and implements enhancements to improve outcomes.
  • Represents the department at regional monthly/quarterly meetings.
  • Represents the health plan in vendor and client meetings.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications

Requires a BA/BS, preferably in a health care field; 5 years business operations and performance management experience; 5 years healthcare industry and case management experience; or any combination of education and experience, which would provide an equivalent background. MA/MS in a health care field preferred. 2 years experience in program implementation including gathering and documenting business requirements, determining scope of work and implementing change management initiatives preferred. LPN/LVN or RN license preferred.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017DiversityInc 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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