Anthem Manager I Medical Management – Clinical Operations - AIM Deerfield - PS7275 in Dearborn, Michigan

Manager I Medical Management – Clinical Operations - AIM Deerfield - PS7275

Location: United States

Field: Medical

Requisition #: PS7275

Post Date: Jul 27, 2018

This position will be located at AIM's Deerfield IL office.

Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater 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.

AIM is currently seeking a registered nurse to be Manager I Medical Management within the Clinical Operations team. Top candidates for this position will ensure targets are met and AIM’s company standards are maintained through exemplary leadership with consistent development and coaching of their team. Through planning, coordination and management of team activities, this position will maintain and enhance the customer experience as well as meet organizational and operational objectives.

Primary duties mayinclude, but are not limited to :

  • Provide management,organization, and coordination of day to day work

  • Create a positive workenvironment for the team through motivation, coaching and associatedevelopment

  • Function as a SubjectMatter Expert for various client plans and AIM products

  • Investigate customer’scomplaints and determine resolution

  • Provide statistical andperformance feedback and coaching on a regular basis

  • Hires, trains, coaches,counsels and evaluates performance of direct reports

  • Address disciplinaryand/or performance problems according to company policy

  • Assist with theoperation of the call center to include the development, analysis andimplementation of staffing, training, scheduling, reward and recognitionprograms

  • Ensure new processes andprocedures are implemented and used effectively by the team while being apositive change agent

  • Ensure a high level ofknowledge within the teams as evidenced through turnaround time of issuesand ability to resolve issues independently

  • Analyze team,department, and product-line data to develop and implement action plansfor improvement

  • Act as liaison withclient Account Managers to ensure customer objectives are being met andcomplaints are resolved

  • Collaborates with alllevels of operations including physician, nurse and non-clinical teams toensure objectives are being met

  • Administers companypolicies and procedures with little or no guidance

  • Monitor ClinicalOperations Nurse Reviewer call center metrics to assure compliance withAIM performance standards

  • Assist in the monitoringof regulatory compliance and health plan timeliness regarding denials andappeals

  • Conduct clinical reviewswith application of Medical Policy and Guidelines as required

  • Attend departmental andother meetings, as required

  • Other duties as assigned

The successfulcandidate will have:

  • Requirescurrent unrestricted nursing license in applicable state(s)

  • 5 years of acute careclinical experience, or any combination of education and experience, whichwould provide an equivalent background

  • Requires strong oral,written and interpersonal communication skills, problem-solving skills,facilitation skills and analytical skills

  • Ability to lead peers inprojects, workload share and identify resources needed to successfullyplan initiatives or projects

  • Good numeracy skillswith the ability to analyze and interpret KPIs to use them to improveperformance

  • Demonstrated ability tocommunicate and manage change within a team, explain reasons for changeand secure team acceptance of change

  • BA/BS degree preferred

  • Knowledge of AIMSpecialty Health products and procedures preferred

  • Call Center experiencepreferred

  • Management experience preferred

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.

An Equal Opportunity Employer/Disability/Veteran