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RN Manager II HCMS - Inpatient...


Job Summary

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

RN Manager II HCMS - Inpatient Review Eagan, MN PS2986

About the Job

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.

RN Manager II HCMS - Inpatient Review Eagan, MN PS2986

Work Location: Eagan, Minnesota
This is an office based position - Monday-Friday 8 a.m. - 5 p.m.

Responsible for managing a team of physical and/or behavioral health practitioners in the development, implementation, and coordination of a comprehensive integrated Medical Management program designed to manage health outcomes in a highly complex member populations with varying degrees of medical complexity and acuity. Participates in case and/or utilization management execution/decision making for managed member populations.

Primary duties may include, but are not limited to:
* Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan.
* Ensures continued compliance with specific medical management standards.
* Engages in the development process for medical and clinical management policy, procedures, and strategies.
* Evaluates medical, mental health, and substance abuse services for cost containment, to include complex/specialized member populations.
* Ensures program deliverables and compliance by monitoring established goals and implementing improvement strategies.
* Takes the lead within assigned area on ensuring the unit is positioned and prepared to execute on quality initiatives and activities including clinical indicators reporting, focus studies, HEDIS reporting and adherence to National Committee for Quality Assurance (NCQA) standards.
* Hires, trains, coaches, counsels, and evaluates performance of direct reports.

* Requires a BA/BS in a related Health/Nursing field; 6 years of experience as aligned to appropriate license, including 3 years prior management experience; or any combination of education and experience, which would provide an equivalent background.
* Current active unrestricted RN, LCSW, LPC, LMHC or other accepted license (as allowed by applicable state laws); and any other state or federal requirements that may apply is required.
* Masters in related Health/Nursing field preferred.
* Certified Case Manager Certification preferred.

Key Qualifications:
* Processional Licensure in the state of Minnesota required; RN licensure Preferred
* Acute Care Experience (i.e. ICU, ER)
* Utilization Management Experience
* Managed Care Experience
* Experience with electronic medical records
* Analytical Skills and Critical Thinking
* Leadership experience
* Project Management skills
* MS Office - especially MS Excel for reporting
* Excellent oral and written communication skills
* Public speaking or training experience a plus

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 please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.


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