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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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Supplier Registration Process

Anthem, Inc.'s supplier registration process will automatically enter your information into our prospective supplier database.

Anthem does not do business with persons or entities identified on the General Services Administration's List of Parties Excluded from Federal Programs and the HHS\OIG List of Excluded Individuals\Entities.

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Anthem's standard payment terms are net 50. Payment terms will be calculated from the invoice date, which should also reflect the date goods or services were received.

Anthem also offers various discount options that provide you with the opportunity for early payment and we are also encouraging our suppliers to participate in our electronic funds transfer (EFT) method of payment. The EFT method of payment will improve the efficiency of our payment processes and ensure that you are paid properly and on time.

Anthem, Inc. Supplier Registration Process

*Please Note: To complete the supplier registration process, you will leave antheminc.com and will be directed to the Ariba Network (AN) site. Once there please click on Register as New Supplier to complete the online registration form and follow the on-screen instructions.

Supplier Registration

Anthem, Inc. utilizes the Ariba Network to determine qualified suppliers that meet Anthem’s business need. Prospective suppliers should complete Ariba’s Supplier Registration Process.*

*Please Note: To complete the supplier registration process, you will leave antheminc.com and enter the Ariba Network (AN) site. Once there, please click on 'Register as New Supplier' on the left-hand side of the screen, complete the online registration form and follow the on-screen instructions.

Anthem does not do business with persons or entities identified on the General Services Administration's List of Parties Excluded from Federal Programs and the HHS\OIG List of Excluded Individuals\Entities.

What to expect next after registration

Anthem Inc.'s Procurement department will review your registration and additional materials. If our sourcing needs align with your goods or services, an Anthem Buyer will contact you to discuss next steps and other pertinent details. If there is no current need, your information will remain in our prospective supplier database for one year for processing against future requests.

Supporting Documents

Guidelines for Prospective Suppliers (PDF)

Company Policy and Procedures (PDF)

To obtain a copy of Anthem's Supplier Travel Guidelines, please send an email to TravelPoint@anthem.com.