VP Care Management, #86839

Company Name:
Anthem, Inc. is one of the nation's leading health benefits companies and a Fortune Top 50 company. At Anthem, Inc., we are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine.
This leader will be responsible for managing medical services, medical costs and improving clinical quality by assuring appropriate health care delivery for Anthem, Inc. members. Will work collaboratively with senior leadership to achieve overall company goals of growth, financial performance and clinical quality improvement.
Primary duties may include, but are not limited to:
Leading the development, implementation, and monitoring of all medical management programs, as well as assessing and implementing innovative programs required by the business.
Monitoring and evaluating ongoing performance of Radiant and ensuring integration into long-term strategy for affordable health care delivery.
Assessing emerging pipeline and real-time medical and pharmacy trends and collaborating with stakeholders to design mitigation plans.
Providing corporate medical leadership to local health plan medical directors to ensure programs achieve targets as a result of successful medical management policies, programs, and initiatives.
Participating in (and where appropriate leading) medical cost initiatives and network development strategy.
Budgets, staffing plans and medical loss ratio projections to assure the adequate allocation of resources to the medical management functions.
Employing rigorous call center process improvement techniques resulting in improved execution, better customer service delivery, and increased cost efficiencies while ensuring quality of the member experience.
Ensuring standardized execution of medical management programs while optimizing workflow tools and processes to support these activities.
Collaborating with National/Local leaders, government programs and internal business units to deliver integrated solutions.
Requires active license to practice medicine without restriction issued by the State Board of Licensure or the State Board of Osteopathic Examiners.
Must be certified in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS). Preferred experience in primary care, internal medicine or family practice
Requires knowledge of regulatory and accreditation agencies and requirements, as well as medical, quality improvement and utilization management practices in a managed care environment.
Minimum of 10 years clinical experience with at least 10 years Leadership/medical management experience.
Demonstrated experience in leading UM and Case/Disease management programs
Experience leading large national or regional medical expense initiatives
Experience leading Quality, (HEDIS) programs
Demonstrated experience in Managed Care.
Prefer MS/MBA
Prior experience analyzing data and identifying drivers of medical cost trends and implementing initiatives to mitigate trends
/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 //. EOE. M/F/Disability/Veteran./
Job Executive
Title: VP Care Management, #86839
Location: AZ-Scottsdate
Requisition ID: 86839

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