Director II Healthcare Management (Louisiana Medicaid)

The health of our associates and communities is a top priority for Anthem.

That priority has become increasingly important as we continue to face the challenges of COVID-19.

Vaccination is the best-known way to protect yourself, your family, and your community.

To keep our associates and communities as safe as possible, Anthem requires all new candidates to become vaccinated against Covid-19.

The best medical evidence shows that masking and testing is not as effective as vaccinations.

All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification.

If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated.

This may be subject to modification depending on the state in which the applicant resides.

Fully vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine or the single dose of a single dose vaccine—the Johnson & Johnson vaccine.

Your Talent.

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 care companies and a Fortune Top 50 Company.

We are hiring a Director II Healthcare Management .

This role will lead our Louisiana Medicaid markets case and utilization management areas, and support population health as it relates to these areas.

Responsible for the development, implementation, and oversight of integrated Medical Management of more than one member population type with varying degrees of medical complexity.

Oversees case and utilization management execution/decision making for managed member populations.

Is accountable to plan executive or executive team member dependent on plan size/complexity and is involved in the development of the strategic vision, goals, and objectives for medical management.

Serves as liaison to state regulatory agencies.

Primary duties may include, but are not limited to:

• Directs and provides leadership for designing, developing, and implementing integrated medical management program to meet the demographic and epidemiological needs of the populations serviced.
• Partners with other health plan/corporate leaders to develop and deliver innovative care management services, root cause analyses and solutions to achieve quality outcomes.
• Directs Healthcare Management Program including disease management, case management, and utilization management.
• Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs.
• Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.
• Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

Minimum Qualifications

Requires a BA/BS degree in a health care field and a minimum of 10 years clinical work experience including prior management experience; or any combination of education and experience which would provide an equivalent background.

Previous experience with NCQA accreditation and HEDIS reporting required.

Preferred Qualifications

RN preferred.

MS/MA degree in a health care field or MBA with Health Care concentration preferred.

Utilization management and case management experience.

Experience working for a managed care organization.

The health of our associates and communities is a top priority for Anthem.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem.

Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem.

Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.

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Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

This may be subject to modification depending on the state in which the applicant resides.

Fully vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine or the single dose of a single dose vaccine—the Johnson & Johnson vaccine.

Anthem, Inc.

is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs.

If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance.

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