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Anthem, Inc. Director I Medical Mgmt. - Medicare-Medicaid (MMP) in Columbia, South Carolina


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.

Director I Medical Mgmt. - Medicare-Medicaid (MMP)

Responsible to lead multiple teams of clinicians charged with promoting quality member outcomes, optimizing member benefits, and promoting 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. Assists management in the administration of the case management and utilization management functions as well as the oversight and assessment of those program's outcomes. Areas managed may include utilization management, case management, and disease management. Hires, trains, coaches, counsels, and evaluates the performance of direct reports.


  • 5-7 years’ acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.

  • Current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States preferred.

  • Prior management experience

  • Must be willing to work cross-functionally and collaboratively with all plan functional departments and support plan wide goals and objectives, also serving as liaison with state regulatory agencies when appropriate.


  • Experience with Medicare Advantage, Medicare-Medicaid plans (MMP), DSNP or integrated plans

  • Case Management leadership background

  • Clinical operations background

  • People leader with background overseeing large clinical operations teams

  • NCQA knowledge

  • BS/BA in a related field; 3 + years of management experience; or any combination of education and experience, which would provide an equivalent background. MBA preferred.

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. 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 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: PS44967-South%5FCarolina