CareMore Manager II Medical Management

Description SHIFT: Day JobSCHEDULE: Full-timeCareMore and Aspire Health are entering a new growth phase, as a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients and currently serve nearly 200,000 patients in 30+ states across Medicare, Medicaid, and commercial populations. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed. 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.

Manages areas which 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.

Serves as mentor to lower leveled managers and as subject matter expert for other areas of the company and within the department.

Manages multiple functions requiring unique sets of knowledge or has significant fiscal accountability.

Develops and manages annual operating budget.

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

Qualifications

Requires 5 years of acute care clinical experience;

2 years or prior management experience; or any combination of education and experience, which would provide an equivalent background.

Current active unrestricted RN license to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required, except in government business where it is preferred.

BS preferred.

For URAC accredited areas the following applies: 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 Diversity Inc. 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: PS39161