Anthem Director I/II Medical Management - IHM St. Louis, MO 122528 in United States

Position Located in St. Louis,MO Relocation open for discussion

Director I or II Medical Management

Anthem Blue Cross and Blue Shield is a proud member of the Anthem, Inc. family of companies. At Anthem we are working 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.

Responsible leading multiple teams 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 utilization management, case management, disease management and demand management.
  • May also manage appeals for services denied.
  • May also manage budget and special projects.
  • Ensures adherence to all contract, regulatory and accreditation requirements.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

  • Requires a BS in a related health care field or nursing

  • 5 years of experience in a health care environment (i.e. acute care) including management experience; or any combination of education and experience, which would provide an equivalent.
  • MS or advanced degree in a clinical nursing specialty, business or healthcare-related field preferred.
  • Current unrestricted RN license in MO is a plus.

/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 Medical

Title: Director I/II Medical Management - IHM St. Louis, MO 122528

Location: MO-St. Louis

Other Locations: United States

Requisition ID: 122528