Manager I HCMS - RN

Description

Your Talent. Our Vision. At Anthem, Inc., 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.

Manager I HCMS

Responsible for managing a team of RN Care Managers and Non-Clinical Medical Management Specialists responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services 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:

• Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions.
• Coordinates service delivery to include member assessment of physical and psychological factors.
• Partners with providers to establish short and long-term goals that meet the member’s needs, functional abilities, and referral sources requirements.
• Identifies members with potential for high-risk complications.
• Reviews benefit systems and cost benefit analysis.
• Evaluates medical, mental health and substance abuse service for cost containment.
• Supports program compliance and assists in identifying opportunities to improve the customer service and quality outcomes.
• Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

Requirements

• Requires a BA/BS; 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.
• Current active unrestricted RN in the State of Missouri required.
• Required experience: OB and/or women’s and children’s health.
• MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred.
• Certified Case Manager Certification preferred.
• People management experience highly preferred.
• Managed care experience required.
• Public Health experience a plus.
• About 25% travel required within the State of Missouri.
• Position is work from home; must reside in the State of Missouri.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.