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Anthem, Inc. Staff Vice President (Medical Director) MSO - CareMore in College Point, New York

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.

CareMore is a proven care delivery model for the highest risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.

What Is CareMore?

CareMore is entering a new growth phase, as a proven care delivery model for the highest risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients and currently serve nearly 150,000 patients in most states across Medicare, Medicaid, and commercial populations. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.

CareMore’s Health Networks, Primary Care+, Touch and CareMore@Home models drive strategy, operations, and care delivery in our national markets. Our comprehensive, upstream approach to health is led by robust multidisciplinary teams of extensivists (managing acute and post-acute episodes of care), primary care clinicians, behavioral health clinicians, care management & engagement specialists (including social workers, case managers and community health workers), virtual care providers, and mobile home-based care teams. We continue to evolve our model to effectively engage and care for complex patients, led by a team of passionate, execution-minded leaders dedicated to this mission.

Responsible for the administration of medical services for company health plans. Primary duties may include, but are not limited to:

  • Manages medical performance for an assigned health services area

  • Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes

  • Responsible for utilization management, case management, pharmacy oversite, HEDIS and Stars activities for the company

  • Supports the Medical Management staff ensuring timely and consistent responses to members and providers

  • Interprets existing policies and develops new policies based on changes in the healthcare or medical arena

  • Identifies and develops opportunities for innovation to increase effectiveness and quality

  • Serves as a resource and consultant to other areas of the company as needed. May chair or serve on company committees and represent the company to external entities and/or serves on external committees and provides guidance for clinical operational aspects of the program

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports and directly supervises the management of any assigned staff. Will manage a team of 250 associates

Qualifications

  • M.D. or D.O.; Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA), must possess an active unrestricted medical license to practice medicine or a health profession.

  • 10 years of clinical experience or any combination of education and experience, which would provide an equivalent background

  • 5 years’ experience in Medicare Advantage MSO operations or similar

  • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

    Preferred requirements:

  • MBA

  • PBM background

  • STARS, HEDIS and Quality experience

  • Experience working with providers as business partners for a managed care or healthplan organization

  • Experience managing a team of Utilization Management/Case Management direct reports (MDs)

    Applicable to Colorado Applicants Only Annual Salary Range*: $290,976 - $363,720 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. * The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

    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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. 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: PS51392-US

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