RN Director l Utilization Mgmt. / Case Mgmt
Posted on: 8 Jan 2021
Lincoln, NE
Job Description
Description
SHIFT: Day Job
SCHEDULE: Full-time
WellCare Nebraska is now a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals. Were 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.
Director l Utilization Mgmt. / Case Mgmt. - Nebraska Medicaid
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
Location: Omaha, Nebraska or Lincoln, Nebraska. (Currently remote with return to office)
The Director l HCMS for Nebraska Medicaid is responsible for managing the utilization and care management process for one or more-member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members. Primary duties may include, but are not limited to:
* Implements and manages health care management, utilization, cost, and quality objectives.
* Ensures program compliance and identifies opportunities to improve the customer service and quality outcomes.
* Oversees the development and execution of medical and case management policies, procedures, and guidelines; assists in developing clinical management guidelines.
* Ensures medical management activities are contracted, reviewed and reported.
* Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.
* Analyze reports/data and make recommendations to improve quality and cost of care.
* Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Qualifications
* BA/BS in a health care field; 8 years of clinical experience, including prior management experience; or any combination of education and experience, which would provide an equivalent background.
* 5 7 years Utilization Management and Case Management experience
* Proficiency in Microsoft Office applications
Preferences:
* Current, unrestricted RN license in the State of Nebraska
* Population health managing social determinants of health
* Experience with Nebraska Medicaid population within managed care industry
Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
Anthem, Inc.
Indianapolis, IN
Anthem, Inc., through its subsidiaries, operates as a health benefits company in the United States. It operates through three segments: Commercial & Specialty Business, Government Business, and Other. The company offers a spectrum of network-based managed care health benefit plans to large and small group, individual, Medicaid, and Medicare markets. Its managed care plans include preferred provider organizations; health maintenance organizations; point-of-service plans; traditional indemnity plans and other hybrid plans, such as consumer-driven health plans; and hospital only and limited benefit products.
The company also provides a range of managed care services to self-funded customers, including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs, and other administrative services. In addition, it offers an array of specialty and other insurance products and services, such as dental, vision, life and disability insurance benefits, radiology benefit management, and analytics-driven personal health care guidance; and Medicare administrative services.
Further, the company provides services to the federal government in connection with the Federal Employee Program; and operates as a licensee of the Blue Cross and Blue Shield Association. As of December 31, 2018, it served 40 million medical members through its affiliated health plans. The company was formerly known as WellPoint, Inc. and changed its name to Anthem, Inc. in December 2014. Anthem, Inc. was founded in 1944 and is headquartered in Indianapolis, Indiana.
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IndustryHealthcare
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No. of Employees63,900
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Website
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Jobs Posted1634
