Anthem Inc. Jobs

Job Information

Anthem, Inc. Senior Leader Clinical Management (Director 2, VP role) in El Paso, Texas

Description

SHIFT: Day Job

SCHEDULE: Full-time

For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a ‘world-class’ candidate experience from the moment you click ‘Apply’! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise.

We are currently seeking a Senior Leader Clinical Management (Director 2, VP role) to join our team. Being located in Little Rock, AR is preferred but we also consider consider candidates in Missouri, Mississippi, Louisiana, Oklahoma and Texas. If you are located outside of the Little Rock area, there will be around 20% travel throughout the year. The Senior Leader Clinical Management (Director 2, VP role) is the owner of the clinical competence, clinical quality, and clinical effectiveness in a health plan model of care. This role works closely with the VP of the health plan model and clinical operations leads.

This role is responsible for the direction and leadership of the overall clinical program. The clinical program includes 2 key components: 1) a performance driven utilization management program including the on-going monitoring of operational performance and workforce management, focus on continuous performance improvement, and the monitoring of utilization data and trends in the assigned region. 2) A state based care coordination program, to ensure members receive the appropriate services to support their plan of care. This position will have oversight of the operational non-clinical and clinical teams (including subcontractors) ensuring all systems are in place to meet regulatory, client and clinical best practices. This position is client and state department/agency facing. This position has a dotted line reporting relationship into the regional market lead who monitors profit and loss for the region and will look to the Director of Clinical Services to assist with market and/or provider strategy initiatives. The clinical programs for the overall state contract include a total medical expense responsibility. This position will require thought leadership in both physical and behavioral health. An ideal candidate will have experience in managing both.

What does a typical day look like?

The Senior Leader Clinical Management (Director 2, VP role) is responsible for ensuring the contract meets all UM and CM performance and productivity targets. Responsibilities include:

  • Oversight of total medical expense and physical health and behavioral health integration activities

  • Provides oversight and direction in the development and implementation of initiatives related to utilization management and associated medical expense

  • Provides oversite of statewide care coordination program including monitoring of adherence to established goals and expectations

  • Continuously monitor processes and procedures and develop recommendations to create efficiencies; direct and oversee recommended changes to processes and systems

  • Ensure corporate policies are followed and local policies and processes are developed to support operations of regional units

  • Maintain a pro-active quality and process improvement program with in line with corporate policies, procedures and protocols, auditing mechanisms and data reporting systems

  • Assist in recruitment, training and evaluation of key UM management

  • Monitor, analyze, and report on trending of utilization data, working with the Regional Market President, Regional Quality Lead, Regional finance lead and VP clinical services to recommend targets; to assess performance against established targets; and to facilitate effective interventions where variance from UM targets may be identified locally or regionally

  • Participate in regional operations and/or finance meetings where MLR and other operational initiatives are discussed that impact UM

  • Collaborate with the regional quality lead to develop provider quality strategies and/or enhancements and improvements to UM and CM strategies (i.e., algorithm changes, etc.)

  • Work with the VP of clinical services to identify necessary changes in UM algorithms to ensure appropriate authorizations are being automated; oversee algorithm adjustments and the operational processes to ensure their accuracy

  • Develops and maintains a positive relationship with providers, advocates and state partners and works to maintain quality outcomes, proper billing, and coordination of care

  • Collaborate on the regional quality committee structure, processes and quality documentation to be in compliance with customer requirements including: preparation of annual documents, development and monitoring of core performance indicators, obtainment of stakeholder input, processing of complaints and development of supportive tools and surveys.

Qualifications

Requires a MS in a mental health field (i.e. social work, counseling) or related field (i.e. nursing); 10 years of clinical experience including case management and leadership experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted license for specific profession (i.e. LCSW, RN,) as required. For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

An Equal Opportunity Employer/Disability/Veteran

REQNUMBER: PS41235-Texas

DirectEmployers