Anthem, Inc. Manager I Healthcare Management (RN, New York) in College Point, New York
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.
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.
We are hiring a Manager I Healthcare Management. Responsible for managing a team of physical health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health 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.
Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.
Manages areas which may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
Applies clinical knowledge to work with facilities and providers for care-coordination. May also manage appeals for services denied.
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 members needs, functional abilities, and referral sources requirements.
Identifies members with potential for high risk complications.
Reviews benefit systems and cost benefit analysis.
Evaluates medical 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.
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 NY required; and any other state or federal requirements that may apply is required.
MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred.
Certified Case Manager Certification 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.