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Mgr I Medical Management - AIM...


Job Summary

Westchester, IL
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Mgr I Medical Management - AIM Westchester IL - PS3191

About the Job

This positions is located at AIM's Westchester IL Contact Center
Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, 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 health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.

AIM is currently seeking a registered nurse to be Manager I Medical Management within the Clinical Operations team. Top candidates for this position will ensure targets are met and AIM's company standards are maintained through exemplary leadership with consistent development and coaching of their team. Through planning, coordination and management of team activities, maintain and enhance the customer experience and meet organizational and operational objectives.
Primary duties may include, but are not limited to:

  • Provide management, organization, and coordination of day to day work
  • Create a positive work environment for the team through motivation, coaching and associate development.
  • Function as a Subject Matter Expert for various client plans and AIM products
  • Investigate customer's complaints and determine resolution
  • Provide statistical and performance feedback and coaching on a regular basis.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  • Address disciplinary and/or performance problems according to company policy.
  • Assist with the operation of the call center to include the development, analysis and implementation of staffing, training, scheduling, reward and recognition programs.
  • Ensure new processes and procedures are implemented and used effectively by the team while being a positive change agent.
  • Ensure a high level of knowledge within the Teams as evidenced through turnaround time of issues and ability to resolve issues independently.
  • Analyze team, department, and product-line data to develop and implement action plans for improvement.
  • Act as liaison with Customer Account Managers to ensure customer objectives are being met and complaints are resolved.
  • Collaborates with all levels of operations including physician, nurse, and non-clinical teams to ensure objectives are being met.
  • Administers company policies and procedures with little or no guidance.
  • Monitor Clinical Operations Nurse Reviewer call center metrics to assure compliance with AIM performance standards.
  • Assist in the monitoring of regulatory and health plan timeline compliance regarding denials and appeals
  • Conduct clinical reviews with application of Medical Policy and Guidelines as required
  • Attend departmental and other meetings, as required
  • Other duties, as assigned

About AIM Specialty Health
AIM Specialty Health (AIM) is a leading specialty benefit management company that promotes appropriate, safe and affordable healthcare services. We are a member of the Anthem family of companies, which is recognized as one of the nation's leading health benefits companies.

AIM provides innovative clinical solutions that focus on today's most complex and costly tests and treatments in radiology, cardiology, medical and radiation oncology, specialty drugs, sleep medicine, musculoskeletal and pain management, genetic testing, palliative care, and other emerging clinical areas.

With evidence-based medicine, technology, people and processes, we support clinical appropriateness review, provider collaboration and member engagement on behalf of more than 50 health plans, 40% of the Fortune 50 Employers, and 43 million members.

Today, our team includes more than 1,100 associates and features more than 600 licensed and board-certified physicians, nurses, and other healthcare professionals who engage with more than 330,000 health care providers across the country. These healthcare providers access our solutions and specialized clinical expertise through our online ProviderPortal and experienced contact center-based teams that is enabled by our business platform.

Our pioneering spirit and dedication to improve health care continues to produce significant industry-first advancements, quality recognition achievements, and high satisfaction rates. AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)

We maintain offices in Chicago, Deerfield, Schaumburg and Westchester, IL, as well as Glendale, CA.

To learn more, visit www.aimspecialtyhealth.com
The qualified candidate will have:
  • Current unrestricted RN license in applicable state(s),
  • 5 years acute care clinical experience,
  • or any combination of education and experience, which would provide an equivalent background.
  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  • Ability to lead peers in projects, workload share and identify resources needed to successfully plan initiative or project.
  • Good numeracy skills with the ability to analyze and interpret KPIs and how to use them to improve performance.
  • Demonstrated ability to communicate and manage change within a team, explain reasons for change and secure team acceptance of change.
  • BA/BS degree preferred
  • Management experience preferred
  • Knowledge of AIM Specialty Health products and procedures would be a plus.
  • Call Center experience 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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