Mgr Medical Director (Care Management) - 39948 - (US-OH-Cincinnati - 45999)

Minimum Education: Tech School
Job Type: Full Time
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Position will be based in Georgia, Virginia, Indianapolis, Cincinnati, or Southern California.

The Managing, Medical Director of Care Coordination and Case/Care Management will be responsible for the administration of medical services for company health plans including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff. Primary duties may include, but are not limited to: leading a 6-physician team focused on National & Commercial Accounts primarily on the identification management, and documentation of Anthem members who can benefit from improved health care coordination and clinical support. Work with Anthem extended executive team who focus on improving Anthem member's health care through improved health care coordination and clinical support. Collaborate with the physician and nursing and non-clinical staff to create, develop and implement tools, processes, and related skills that will improve member health reduce readmissions and help Anthem members improve their health, supporting Anthem members medical needs at the most appropriate setting and using the appropriate resources. Additional responsibilities include the administration of medical services for company health plans to ensure clinical integrity of broad and significant clinical programs, including the overall medical process of the business unit.

Be one of the leaders of Anthem's medical management team to improve the efficiency and effectiveness of Anthem's medical management process across all clinical areas. Duties may include, but are not limited to: Interprets existing policies and develops new policies based on changes in the healthcare or medical arena. Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. Supports the Medical Management staff ensuring timely and consistent responses to members and providers .Identifies and develops opportunities for innovation to increase effectiveness and quality. Serves as a resource and consultant to other areas of the company. May chair or serve on company committees. May be required to represent WellPoint to external entities and/or serve on external committees. Management duties include hiring, training, coaching, counseling and evaluating performance of direct reports.

Skills:
Position requires MD and 5 or more years of experience in managed care with case/care management experience, and 10 years of increasingly responsible professional experience. Requires board certification where applicable to the duties being performed. WellPoint is ranked No. 1 among health insurers on Fortune Magazine's annual list of America's Most Admired Companies and has been named as one of the Top 50 Companies for Diversity by DiversityInc Magazine.

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