Mgr I Medical Mgmt - Atlanta, GA - PS35836

Description SHIFT: Day JobSCHEDULE: Full-timeYour 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.Mgr I, Medical ManagementLocation: Atlanta, GAResponsible 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. Qualifications

Current active unrestricted RN license to practice as a health professional within the scope of practice in the state of Georgia

5 years acute care clinical experience or any combination of education and experience, which would provide an equivalent background.

Utilization Management or Case Management experience preferred.

Experience with Medicaid regulations and contracts preferred.

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 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.REQNUMBER: PS35836