SHIFT: Day Job
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.
This is an office based position and will be required to report to 9133 West Russell Road Las Vegas, NV post Covid. Remote work within the state of NV will be allowed until Anthem is cleared to return to the office.
The selected candidate will be supporting the NV Medicaid market, including implementation of new products, supporting the plan President and operations lead. This associate will be the go to person for the state on a daily basis.
Responsible for operations functions, including coordination between internal departments, ensuring the appropriate strategy, tactics and processes are in place to affect solid organizational operations and oversight.
Primary duties may include, but are not limited to:
Champions initiatives by developing and managing key relationships with state agencies, regulatory, Medicaid/SCHIP and other stakeholders as appropriate.
Resolves programmatic challenges related to operations including member issues, provider claims issues, provider network/contract configuration issues, etc.
Serves as liaison to Health Plan support services, which could include: Claims, Enrollment, NCC, PDM/PDQ, configuration; Quality, Regulatory Compliance, IT, Reimbursement policy, etc.
Identifies opportunities for Operational Excellence and works to create seamless processes between shared services and the Health Plan.
Develops and implements key operational indicators to be used for monitoring and analysis of the Health Plan operations.
Serves as a liaison with state regulatory agencies when appropriate.
Resolves programmatic challenges related to program operations including member issues, provider claims and provider network.
Represents business unit on national/state/regional boards, task forces, and work groups that impact the health care delivery system and other key health care issues.
Collaborates with senior management to develop and implement new programs to enhance relationships with key stakeholders and to promote programs and services.
Ensures all policies and procedures related to Field Operations are compliant with all applicable laws and regulations governing the State Sponsored Business.
- Requires a BA/BS in Business, Healthcare Administration or related field
- 10 years of relevant experience including 8 years of in-depth experience in managed care operations
- Or any combination of education and experience, which would provide an equivalent background
- Masters degree preferred
- Six Sigma Black Belt preferred
This is a Director level position, operating as an individual contributor without direct reports.
OPERATIONS EXPERIENCE / PROVIDER CONTRACTING EXPERIENCE A PLUS
FACETS KNOWLEDGE A PLUS
STRONG COMMUNICATION SKILLS
PEOPLE MANAGEMENT A PLUS
MEDICAID EXPERIENCE A PLUS
ABILITY TO MEET WITH PROVIDERS WHEN NECESSARY
Anthem, Inc. is ranked as one of America’s 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.