Mgr I Medical Mgmt - FHPS - PS38439

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Anthem Blue Cross and Blue Shield, a proud member of the Anthem, Inc. family of companies, 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. 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.

Qualifications

Requires current active unrestricted RN license to practice as a health professional within 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 2019 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: PS38439