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Medical
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PS19727 Requisition #
Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, 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 office-based in our Raleigh/Durham region, and remote in our Asheville, Winston-Salem/Greensboro, Charlotte, Fayetteville, and Greenville regions.  North Carolina residency is required.  Licensure is required (see job description for accepted licenses).
 

The Manager, HCMS is responsible for managing a team of physical and/or behavioral health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse 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.
  • 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 member’s needs, functional abilities, and referral sources requirements.
  • Identifies members with potential for high risk complications. Reviews benefit systems and cost benefit analysis.
  • Evaluates medical, mental health and substance abuse 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.

  • North Carolina residency is required.
  • Current active unrestricted RN, LCSW, LPC, LMFT, LMHC, LMSW or other accepted clinical license from the state of North Carolina.
  • Minimum of BA/BS in a related Health/Nursing field required.
  • 6+ years of experience as aligned to appropriate license, including 3 years prior case management or utilization management experience; or any combination of education and experience, which would provide an equivalent background, is required.
  • 3+ years of direct managerial experience required.
  • Managerial experience in a managed care environment preferred.  
  • Certified Case Manager Certification (CCM) preferred.
  • Occasional local travel in the state of North Carolina required (20-25%).

 


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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Be Part of an Inclusive Culture

Workforce Diversity

At Anthem Inc., we believe that having a diverse workforce is critical to innovation and to addressing the needs of the diverse customers and communities we serve. Women make up 76% of our workforce and 63% of all management roles. People of color represent 43% of our workforce and 29% of management. More about the breakout of our workforce in Anthem Corporate Responsibility.

Workforce Recruitment

Our commitment to improving access to affordable care while simplifying the health care experience for consumers requires the best talent, passion, broad insight and experience, and an innovative mindset.

We partner with external organizations, colleges and universities, and our nine associate resource groups to recruit, retain, and develop a workforce that reflects the communities we serve -- and to implement best practices to offer an inclusive environment for all. Our partnerships include: UNCF, United States Business Leadership Network (USBLN); National Association on Disability (NOD), Amerigroup National Advisory Board; Easter Seals; Job Accommodation Network (JAN); MindShift; VeteranRecruiting; HirePurpose; Hiring Our Heroes; Military Spouse Corporate Career Network; Out & Equal; Hispanic Association on Corporate Responsibility (HACR); Diversity Best Practices, among many others.

Associate Resource Groups

Our nine Associate Resource Groups (ARGs) include associates from all areas of the organization, multiple locations and a wide-range of experiences and backgrounds. The groups encourage diversity of perspectives and insight and help put the passion of our associates into action in order to make a real difference for our consumers and the communities we serve. Our ARGs help tackle business issues, participate in community programs, and facilitate opportunities for education, development, and networking. ARGs are open to all Anthem associates.

  • ABLE: Disability Inclusion Network Abilities Beyond Limited Expectations
  • ACE Asians Committed to Excellence
  • APEX African American Professional Exchange
  • HYPE Healthcare Your Professional Exchange
  • PRIDE Promoting Respect, Individuality, Diversity and Equality
  • SOMOS Hispanic ARG
  • VOA Veterans of Anthem
  • W@VE Working @ Anthem in a Virtual Environment
  • WIN Women’s Inspired Network

LGBTQ inclusion – SAFE Space and Gender Transition Guidelines

We are proud to be recognized by the HRC among the Best Places to Work for LGBTQ Equality by obtaining a perfect score in the Corporate Equality Index. Our PRIDE ARG helps us identify and implement best practices and programs such as the Anthem Safe Space Program, the Gender Inclusion and Transition Guidelines, and Transgender Training for customer-facing associates. This ARG also helped create “Building an LGBT –Friendly Practice”, an online training module that we offer to all health care providers.

People with Disabilities

We have a strong commitment to the employment of people with disabilities and partner closely with external organizations and our ABLE ARG to nurture a culture and a physical environment that are both inclusive of associates as well as customers with disabilities. We have received the Leading Disability Employer Seal by NOD (2016-2017), a perfect score in the USBLN’s Disability Equality Index since 2016 and the Portlight “Getting It Right” Award in 2017 for our work in disaster preparedness and recovery for people with disabilities.

Veterans

It's important to us to offer our veterans opportunities to take their career in a new direction because we believe their spirit of service is essential to improving health care. Our VOA ARG partners with Talent Acquisition to maximize our ability to attract and retain veterans and their family members. The group also focuses on supporting our troops by sending care packages during the holidays and participating in events year-round. Learn more in our veterans’ page.

Unconscious Bias training

We train our leaders to make more informed and effective decisions by mitigating unconscious bias. There’s extensive research about the impact of unintended bias in decisions that affect people in the workplace so in 2017 we launched “Decide: The Neuroscience of Breaking Bias,” an eLearning experience that helps leaders identify, label and take action to minimize bias in order to build effective and inclusive teams.

Connect With Our Communities

Our associates are passionate about serving our members and giving back to the community and the company supports these efforts through several programs.

Year-round, Anthem associates give generously to health-related nonprofit organizations across the country through our Associate Giving Program, which offers a 50 percent match from the Anthem Foundation.

The Dollars for Doers program encourages year-round associate volunteerism—and helps associates’ commitment go even further by providing grants to eligible organizations where the volunteer service is completed. In 2017, our associates logged over 55,000 hours! To make it even easier to volunteer, associates can have up to eight hours of paid volunteer time off each year to be used to volunteer at qualified charities of their choice.

The Volunteer Recognition Program invites Anthem associates to share their volunteer stories or nominate their colleagues who volunteer in the community. Each quarter associates nominate and vote for a winner who exemplifies our value of Caring for Our Communities. The winner chooses an eligible charity to receive a special grant from the Anthem Foundation.

Learn more about how Anthem associates give back to their communities.

 
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