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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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Interns must have completed two years of college, be enrolled in an accredited university or college and have a 3.0 or above grade point average. Additionally, intern candidates will typically have:

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