Dir I HCMS – New York Medicaid job in buffalo, ny



SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. 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.

Title: Director I UM / CM New York Medicaid

Preferred Location: Candidates who reside in the New York area for proximity to our Buffalo, NY office. Must be willing to travel to this location as needed for meetings. In the future, this position may be office-based.

Note: Candidates must reside within commuting distance to an Anthem office and be willing to work from an Anthem office in the future if required.

This role is critical to maintaining the success of the Alliance partnership. The Director l HCMS is responsible for managing the utilization or care management process for our New York Medicaid member 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 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.
  • Hires, trains, coaches, counsels, and evaluates the performance of direct reports.



  • 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.
  • Current, unrestricted RN license in the state of residence required and ability to obtain unrestricted RN license in the State of New York.
  • Experience with New York Medicaid population within managed care industry strongly preferred.
  • 5 – 7 years formal people management / leadership experience required.
  • 5 – 7 years Utilization Management (required) and Case Management experience with background in population health managing social determinants of health.
  • Provider Contracting and Claims Payment experience strongly preferred.
  • National Committee for Quality Assurance (NCQA) accreditation, EQRO audit experience and HEDIS reporting experience preferred.
  • Masters in a health care field or MBA with Health Care concentration preferred.
  • Certified Case Manager preferred.
  • Proficiency in Microsoft Office applications is required.
  • Must be willing to travel to our Buffalo, NY office for meetings, training, etc as needed.

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.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.

24 hours ago


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