Director II Healthcare Management (Louisiana Medicaid) – Baton Rouge



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.

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.


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 require all new candidates to become vaccinated against COVID-19. 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 that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

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 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.

REQNUMBER: PS62837-Baton%20Rouge-Baton%20Rouge


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