Anthem, Inc. Staff VP Cost of Care and Quality Management in Reno, Nevada
SHIFT: Day Job
Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.
For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
The Staff VP, Cost of Care and Quality Management is a key leadership role on the CMO team within Beacon Health Options and is responsible for leading and coordinating clinical initiatives and business performance across the CMO function, and overseeing cost of care in partnership with Network and Market teams. This role will work closely with the different clinical functions - Medical Directors, Care Management, Clinical Strategy and Quality to ensure optimal coordination and execution on key business activities. The Staff VP, Cost of Care and Quality Management will directly lead several key teams, including: Cost of Care Appeals and Grievances Provider Quality Management
KEY RELATIONSHIPS Reports to: Chief Medical Officer, Beacon Health Options Staff: Leaders in Cost of Care, Provider Quality Management, Appeals & Grievances and Process Improvement.
Directly lead and evolve the physician shared services model creating best practices for utilization management and ensuring that we strike the right balance between supporting the individual clients and efficiently utilizing Beacon resources across the enterprise. Directly lead Appeals and Grievances team, ensuring compliance with all related requirements In collaboration with Network leader and Health Economics team, drive Enterprise process for cost of care tracking, oversight and annual planning. Leads the team responsible for evolving the clinical provider strategy to improve member outcomes, high levels of provider performance and improvement in healthcare costs. Provides oversight and direction on Centers of Excellence strategic pillars, as assigned Provides behavioral health SME support for Provider related strategies including SIU, Payment Integrity. Represent clinical division for development of market competitive analytics and reporting. Serves as the legal interface on behavioral health issues providing guidance and expertise. Represent clinical division for Mental Health Parity related Enterprise work and ensure standards of compliance are met. Serve as a conduit for all clinical functions with the business development/account management teams to support bids for new business, developing resourcing models and cost models. Ensures the models accurately represent the clinical strategy and needs for the business. Provide oversight of budget performance for clinical division. Lead several operational functions including: Centralized MD scheduling and contracted clinician credentialing Represents Beacon on external workgroups and organizations Champion a dynamic growth culture by driving revenue, profitability and initiatives aligned with the company’s mission, vision and values. Recruit, develop and retain key talent through coaching, training, and leadership development. Leads large scale, complex corporate strategy projects that are cross-organizational in nature and large, impactful national partnerships. Provides direction and guidance to various BU leads in developing specific business plans and strategies. Assists executive leadership in assessing current environment external factors and competitive landscape. Facilitates development of key strategies. Identifies opportunities to coordinate across the business more effectively to optimize value. Engages business planning leaders within the respective business divisions to identify innovative growth and efficiency opportunities to achieve performance targets and gain market distinction. Evaluates strategic options in the context of the corporate strategic direction financial targets and market context. Helps evaluate/re-evaluate ongoing initiatives in light of the changing environment to recommend corrective action. Develops and executes logical analysis to drive toward key decisions and to drive change. Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a BA/BS in a related field or related experience including prior leadership; or any combination of education and experience, which would provide an equivalent background. Master’s degree in business administration and/or health related field preferred. 15+ years of direct experience in a managed care organization; behavioral health preferred Senior level leadership within a managed care organization Strong knowledge of behavioral health industry with related experience Proven experience leading teams - developing and mentoring talent Ability to work across the matrix and influence stakeholders to get work done Ability to lead multiple initiatives at one time Strong communication skills
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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.