Anthem Dir I, II HCMS #PS1045 in Hesperia, California
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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.
**Please note: This position may be filled at either the Director I or Director II level.
position supports the Government Business Division's Case Management/ Disease Management Unit.
Primary duties may include, but are not limited to: • Leads a team with the primary responsibility to develop/execute case management / population health/health promotion initiatives. • Drives development of the strategic vision, goals, and objectives for CM program enhancement. • Identifies CM member engagement best practices/processes and drives implementation. • Supports the CM NCQA accreditation process and ensures that the CM program continues to meet/exceed NCQA standards. • Partners with health plan/corporate leaders to develop and deliver innovative care management services, root cause analyses and solutions to achieve quality outcomes. • Implements and manages health care management, utilization, cost, and quality objectives. • Ensures program compliance and identifies opportunities to improve the customer service and quality outcomes. • Oversees the development and execution of medical and case management policies, procedures, and guidelines; assists in developing clinical management guidelines. • Oversees case/disease management reporting process, including setting requirements, working with technical teams, implementing communication plan. • Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting. • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Director I: Requires a BA/BS in a health care field; 8 years of clinical experience, including prior management experience; or any combination of education and experience, which would provide an equivalent background. RN preferred.. National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience preferred. Masters in a health care field or MBA with Health Care concentration preferred. Certified Case Manager preferred.
Director II: Requires a BA/BS in a health care field; 10 years of clinical work experience, including prior management experience; or any combination of education and experience, which would provide an equivalent background. Previous experience with NCQA accreditation and HEDIS reporting required. RN preferred. Masters in a health care field or MBA with Health Care concentration preferred
Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Dir I, II HCMS #PS1045
Requisition ID: PS1045