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Director I Healthcare Management Services - Buffalo, New York (office-based) PS27381

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Medical
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PS27381 Requisition #

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 healthcare.

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.

 


Location:  This position is responsible for our western New York region, and is office-based in Buffalo.  Occasional travel to other offices is required for meetings, etc.

 

 

Responsible for managing the utilization or care management process 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:

 

  • 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.
  • Ensures medical management activities are contracted, reviewed and reported.
  • Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

  • A Bachelor of Science in Nursing is required.
  • A current, active, unrestricted RN license issued by New York is required.
  • 8+ years of clinical experience is required.
  • 3+ years of management/leadership experience is required.
  • Managed Care experience is strongly preferred.
  • Experience working with the Medicaid population is strongly preferred.
  • Master's degree in a healthcare field or MBA with healthcare concentration is preferred.
  • National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience is preferred.
  • Certification Case Manager is preferred.
  • Proficiency in Microsoft Office applications, including Excel, is required.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 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

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Actuarial

Program Overview

Our Actuarial Internship Program allows students to gain valuable experience in the actuarial field, as well as in a dynamic health care environment. Through actuarial careers with Anthem, Inc., you will have the opportunity to help drive the future of health care, by finding ways to make health care more affordable and more valuable to the public.

Highlights

  • Interns are assigned a mentor who will serve as an informal guide
  • Students present their projects to senior leadership in person and through live video conferencing
  • Students will gain experience working on a variety of real actuarial projects alongside actuaries of varying experience
  • Daily interaction with mentors and final evaluations provide two-way feedback and opportunities to discuss future employment interests

Qualifications

Successful candidates typically possess:

  • Current enrollment in an accredited college or university and planned continued enrollment after internship period
  • High GPA (or a combination of experience and GPA)
  • Participation in an actuarial science, math, or statistics program
  • Commitment to an actuarial career (participation in an actuarial club, math associations, attendance at actuarial conferences, etc.)
  • Adaptability
  • Rapid learning ability
  • Effective teamwork and written/verbal communication skills

Exams

It is not required that you have passed an exam to participate as an actuarial intern; however, we like to know that you plan on taking one during the current/upcoming school year.

Timeline and On-campus Events

  • Fall (Sept/Oct) – look for information sessions and on-campus interviews through your career center. If you do not see your campus listed, please apply to the job through our careers site by typing “Actuarial Intern” in the keyword search field

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