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Manager (Nurse req'd) - Health Care Mgmt - Medicaid/Medicare - Tidewater, VA (126289)
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Norfolk, VA Norfolk, Virginia |
About this job
Description
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.
Location: Required training will last a minimum of 2 weeks in the Richmond, Virginia office. Once training has been completed satisfactorily, there will be an option to work from your home office when not in the field working with your direct reports.
The Manager l HCMS is responsible for managing a team of physical and/or behavioral health practitioners responsible for coordinating the Virginia Commonwealth Care Coordination + member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services 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:
* Manages and oversees team responsible for ensuring contractual requirements.
* Coordinates service delivery to include member assessment of physical and psychological factors.
* Identifies members with potential for high risk complications.
* Reviews benefit systems and cost benefit analysis.
* Evaluates medical, mental health and substance abuse service for cost containment.
* Supports program compliance and assists in identifying opportunities to improve the customer service and quality outcomes.
* Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
* Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications
Requires:
* BA/BS; 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.
* Current active unrestricted RN license in the State of Virginia.
* MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred.
* Certified Case Manager Certification preferred.
* Leadership experience preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 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.
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.
Location: Required training will last a minimum of 2 weeks in the Richmond, Virginia office. Once training has been completed satisfactorily, there will be an option to work from your home office when not in the field working with your direct reports.
The Manager l HCMS is responsible for managing a team of physical and/or behavioral health practitioners responsible for coordinating the Virginia Commonwealth Care Coordination + member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services 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:
* Manages and oversees team responsible for ensuring contractual requirements.
* Coordinates service delivery to include member assessment of physical and psychological factors.
* Identifies members with potential for high risk complications.
* Reviews benefit systems and cost benefit analysis.
* Evaluates medical, mental health and substance abuse service for cost containment.
* Supports program compliance and assists in identifying opportunities to improve the customer service and quality outcomes.
* Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
* Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications
Requires:
* BA/BS; 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.
* Current active unrestricted RN license in the State of Virginia.
* MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred.
* Certified Case Manager Certification preferred.
* Leadership experience preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 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.