Anthem Manager I Medical Management - PSCCR - Any Anthem Location or Telecommute - 129782 in Andover, Massachusetts

/ Your Talent. Our Vision. / At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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: Any Anthem location or telecommute. Candidate should be located within driving distance from an Anthem office.

Manager Medical Management I

Responsible to manage a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Primary duties may include, but are not limited to:

  • Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.
  • Areas managed may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
  • Applies clinical knowledge to work with facilities and providers for care-coordination.
  • May also manage appeals for services denied.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Manager Medical Management I

  • Requires current active unrestricted RN license to practice as a health professional wihtin the scope of practice in applicable state(s) or territory of the United States, except in government business where it is preferred, and 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.

/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at//www.antheminc.com/careers//. EOE. M/F/Disability/Veteran./

Job Medical

Title: Manager I Medical Management - PSCCR - Any Anthem Location or Telecommute - 129782

Location: MA-Andover

Requisition ID: 129782