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( RN ) Provider Clinical Liaison - PS 15687 - (Anthem TN location or TN Remote)

PS15687 Requisition #
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Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s 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. 
This position may be remote within TN and will be responsible for overseeing the middle region of TN.  Home office location:  22 Century Blvd.,  Nashville, TN
The Provider Clinical Liaison supports primary care groups in population health activities.  This position serves a key role in Amerigroup Tennessee’s geographically organized provider support.  The Clinical Liaison is responsible for managing quality and medical expense goal metrics for primary care groups by assisting in connecting high risk members and those having HEDIS gaps to their medical homes, to establish care plans that improve health outcomes.  Primary duties include:
  • Use Amerigroup/Anthem databases and tools, including PCMS, to identify opportunities for improvement in quality and costs for members in assigned practices;
  • develop an operational plan for each medical practice to deploy office personnel and coordinate with Amerigroup resources to optimize performance on targeted quality measures and to improve clinical and cost outcomes for members identified to have high clinical risk;
  • coordinate scheduling of high risk members and those having HEDIS gaps for appointments;
  • communicate with medical office personnel about identified gaps in care that will be apparent to the practitioner at the patient encounter;
  • meet with physicians and other clinical personnel to problem solve and develop engagement plans for high risk members;
  • work with practitioners and office staff to improve documentation of diagnoses, including specific manifestations, facilitate access of members to Amerigroup/ Anthem case management, population health, and behavioral health programs as indicated, and help coordinate services provided by practice and Amerigroup/ Anthem personnel;
  • serve as the subject matter expert for primary care practices on all Amerigroup/ Anthem clinically focused programs;
  • conduct periodic meetings with each practice to track progress towards implementing the project plan and attaining goals established in the engagement contract;
  • support the Amerigroup TN Provider Engagement Lead in organizing and implementing support to achieve targeted revenue, medical expense, and quality goals for the assigned region; and
  • AnEqualOpportunityEmployer/Disability/Veteran
  • BA/BS in Nursing
  • Minimum 5 years of clinical experience
  • Demonstrated commitment to clinical quality improvement
  • Unrestricted RN license in the state of Tennessee
***This position requires field work, visiting providers, approximately 75% of the time.***
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

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