Anthem, Inc. Director Healthcare Management in Apple Valley, California
SHIFT: Day Job
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.
We are hiring for a Director of Healthcare Management. 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 care companies and a Fortune Top 50 Company.
Responsible for integrated care management services for the Commercial Individual segment . Primary duties may include, but are not limited to:
Manages care management delivery teams which include Utilization Management inclusive of Inpatient, Outpatient and Post Service Clinical Claims Review (PSCCR), Case Management, and clinical programs.
Delivers quality, high touch, customer responsive, and cost effective care.
Leads care delivery teams providing integrated solutions including behavioral health, wellness, pharmacy, and provider partnerships.
Manages medical loss ratio.
Partners with Clinical Shared and Specialty Services and regional leadership to deliver market leading care management services, root cause analyses and solutions to achieve engagement and quality outcomes.
Develops and manages communications on Anthem Care Management (ACM) issues and opportunities.
Develops and implements process redesign and programmatic improvements.
Serves on internal and external quality and provider committees.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a BA/BS; 10 years of experience in managed care/health care environment or related field, including 4 years of management experience; or any combination of education and experience, which would provide an equivalent background.
Experience working in a matrixed environment
Medicaid experience preferred
RN licensure preferred
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.