Dir Medical Mgt - 42030EB - (US-CA-Anaheim - 92899)

Minimum Education: Tech School
Job Type: Full Time
Email this job to yourself or to a friend | Job Match Test | Resume Guide

WellPoint
is the nation's leading health benefits company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to be the most trusted choice for consumers and a leader in affordable quality care with an unyielding commitment to meeting the needs of our diverse customers.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Responsible to lead multiple teams of clinicians charged with promoting quality outcomes for Workers' Compensation Injured Workers, to optimize Client value, and to promote effective use of resources. In addition, this position will assist with Medical Management product design and implementation of products in various states.

Primary duties may include, but are not limited to adherence to medical policy in providing service that is medically appropriate, high quality, and cost effective. Areas managed include utilization management and case management departments. Position is responsible for compliance to individual state Workers' Compensation regulations as well as maintaining URAC compliance and accreditation. Anthem Workers' Compensation is URAC accredited in Utilization Management, but in the future may involve additional accreditation areas. Responsible for supervision of the Quality Assurance department managing grievances filed by Clients and Injured Workers as well as regulatory issues.

In the course of managing the Quality Assurance department oversight will be directed to quality initiatives for the staff and quality improvement projects.

Skills:
Requires BS in nursing or related health care fields, 5-7 years experience in a health care environment (i.e. clinical care), and prior management experience, or any combination of education and experience, which would provide an equivalent background. MS or advanced degree in a clinical nursing specialty, business or healthcare-related field strongly preferred. Workers' Compensation system knowledge and experience preferred. Current unrestricted RN license in applicable state(s) required. 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

To apply copy and paste the link below into your browser:

http://hispanic-jobs.com/view.php?job_id=89199&type=search&auth_sess=7l4d0eget47e7c0sal938hsob5&ref=f195a52933eda4a143cd74a67

There are so many more positions in any industry in all cities and states available on our website. Hispanic-Jobs.com specializes in jobs for bilingual English/Spanish-speaking professionals and applying to all jobs is free. Take a look, there are many wonderful opportunities available. Go directly to www.Hispanic-Jobs.com