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Medical
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PS27649 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 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.

 

Manager Oversight Compliance

 Location:  Any CA Anthem Office


Summary: The Manager, Oversight Compliance is responsible for managing clinical auditors of delegated provider organization throughout the state of CA for multiple lines of business.


Primary duties may include, but are not limited to: 

  • Develops and manages favorable working partnerships and relationships with delegated entities, physicians, healthcare service providers, and internal customers to improve the delivery and quality of health care.
  • Manages annual and ad hoc delegation oversight audits, analyses of performance measures, reporting, and development of corrective action plans. 
  • Leads intervention activities to enhance communication and educate.
  • Designs programs and strategies to assist delegated entities in meeting standards and improving quality outcomes. 
  • Develops operations processes and ensures standardization of procedures and documentation.
  • Negotiates with delegated entities and internal constituents as needed.
  • Leads healthcare industry initiatives that involve the standardization and streamlining of regulatory oversight functions. 
  • Provides support for litigation issues surrounding regulatory compliance.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications:
  • BS; 6 years of acute care, utilization management, quality management in a hospital or provider organization that was delegated for HMO services with 3 years of management experience and 3 years of experience in conducting oversight audits of delegated entities and/or ancillary providers; or any combination of education and experience, which would provide an equivalent background. 
  • May require some travel 20%
  • Current unrestricted RN license in applicable state(s) required.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc 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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Life At Anthem

There’s something truly unique going on within Anthem. Everywhere you look, you’ll find smart, passionate people looking for ways to drive the future of health care by making a positive impact.

So what drives us? We’re guided by a powerful set of Values – shared priorities that influence our every interaction with each other, our customers and our community.

We encourage associates to be Innovative, Trustworthy and socially responsible.

We’re committed to being Easy-to-Do Business With; striving always to make things easier for customers.

We work together, with each other and with the people we serve, and we make a real difference by Caring, treating our customers the way we want to be treated.

We demand Accountability, and we take joy in recognizing those who lead by example – at work, and in the community.

We treat others the way we want to be treated, and it makes all the difference. If you’re looking for an opportunity to work with a forward-thinking industry leader, there’s not better place to find yourself than here!

Anthem’s Standards of Ethical Business Conduct (Code of Conduct) guides our actions and supports our values.