• Anthem
  • $98,970.00 -156,660.00/year*
  • South Portland , ME
  • Executive Management
  • Full-Time
  • 107R Huntress Ave


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Director I HCMS - PS19891

Location:United States

Requisition #: PS19891

Post Date: May 17, 2019

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were 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.

Preferred Office Location: Seattle, WA or Las Vegas, NV

May consider California location

Job Summary:

This is a regional position supporting 3 States: Washington, Nevada and California. 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:

  1. Implements and manages health care management, utilization, cost, and quality objectives.

  2. Ensures program compliance and identifies opportunities to improve the customer service and quality outcomes.

  3. Oversees the development and execution of medical and case management policies, procedures, and guidelines; assists in developing clinical management guidelines.

  4. Ensures medical management activities are contracted, reviewed and reported.

  5. Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.

  6. Responsible for Compliance reporting.

  7. Ability to manage and implement cost of care initiatives and own processes.

  8. Hires, trains, coaches, counsels, and evaluates performance of direct reports.

  • Requires a BA/BS in a health care field.

  • 8 years of clinical experience, including prior management experience.

  • 3-5+ years of leadership experience.

  • Any combination of education and experience, which would provide an equivalent background.

  • A current unrestricted RN license in California, Washington or Nevada preferred.

  • National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience preferred.

  • Masters in a health care field or MBA with Health Care concentration preferred.

  • Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) experience required.

  • Managed care experience preferred.

Anthem, Inc. is ranked as one of Americas 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


Associated topics: ad, alumni, facebook, lead generation, major gift, media, policies, principle gift, relationship, university relationship

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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