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Mgr I Medical Management - AIM Westchester IL - PS20486

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Medical
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PS20486 Requisition #
This positions is located at AIM's Westchester IL Contact Center
 
Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies,  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.  

Top candidates for this position will ensure targets are met and AIM’s company strategy is achieved through consistent development and coaching of their team. Through planning, coordination and management of team activities, maintain and enhance the customer experience and meet organizational and operational objectives.

 
Primary duties may include, but are not limited to
  • Provide management, organization, and coordination of day to day work
  • Create a positive work environment for the team through motivation, coaching and associate development.
  • Function as a Subject Matter Expert for  various client plans and AIM products
  • Investigate customer’s complaints and determine resolution
  • Provide statistical and performance feedback and coaching on a regular basis.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  • Address disciplinary and/or performance problems according to company policy. 
  • Assist with the operation of the call center to include the development, analysis and implementation of staffing, training, scheduling, reward and recognition programs.
  • Ensure new processes and procedures are implemented and used effectively by the team while being a positive change agent.
  • Ensure a high level of knowledge within the Teams as evidenced through turnaround time of issues and ability to resolve issues independently.
  • Analyze team, department, and product-line data to develop and implement action plans for improvement.
  • Act as liaison with Customer Account Managers to ensure customer objectives are being met and complaints are resolved.
  • Collaborates with all levels of operations including physician, nurse, and non-clinical teams to ensure objectives are being met.
  • Administers company policies and procedures with little or no guidance.
  • Monitor Clinical Operations Nurse Reviewer call center metrics to assure compliance with AIM performance standards.
  • Assist in the monitoring of regulatory and health plan timeline compliance regarding denials and appeals
  • Conduct clinical reviews with application of Medical Policy and Guidelines as required
  • Attend departmental and other meetings, as required
  • Other duties, as assigned
The successful candidate will have:
  • Requires current unrestricted nursing/ PT license in applicable state(s),
  • 5 years acute care clinical experience, or any combination of education and experience, which would provide an equivalent background.
  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  • Ability to lead peers in projects, workload share and identify resources needed to successfully plan initiative or project.
  • Good numeracy skills with the ability to analyze and interpret KPIs and how to use them to improve performance.
  • Demonstrated ability to communicate and manage change within a team, explain reasons for change and secure team acceptance of change.
  • BA/BS degree preferred
  • Knowledge of AIM Specialty Health products and procedures preferred
  • Call Center experience preferred
  • Management experience preferred.
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 antheminc.com/careers.

An Equal Opportunity Employer/Disability/Veteran

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