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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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As one of America’s largest health benefits companies, we at Anthem have a profound appreciation for service. Our organization proudly supports our nation’s active, reserve and veteran military service members and their spouses.

This is an exciting opportunity to advance your life and career, while still protecting and serving others. Come see for yourself why Anthem is recognized as a Top Employer by GI Jobs and among the “Best of the Best: Top Veteran Friendly Companies” by US Veterans Magazine.

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