SHIFT: Day JobSCHEDULE: Full-timeYour Talent.
Our Vision.
At Anthem, Inc., it’s a powerful combination, and 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.This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune Top 50 Company.Travel: The primary function is provider office location auditing.
Local travel is necessary and is often same day to and from home.
Overnight stays are a possibility but rare.
Travel varies but is an average of 2 x’s per week.
Presently, auditing functions can be done virtually.
In-person audits are voluntary until 2022 due to the PHE.This nurse will cover Los Angeles County, but could be asked to travel anywhere in CA as needed.This is a W@H position, but if needed, the reporting office would be 425 E Colorado St, Ste 600, Glendale, CA 91205 Responsible for Patient Centered Care (PC2) program implementation focusing on partnering and building relationships with providers and their office staff to support provider’s understanding of disease and case management.Primary duties may include, but are not limited to:Serves as the clinical point of contact for providers and primary care practices for orientation, on-going training, and support for the practice’s clinical coordination and care management team regarding Anthem clinical programs and case management concepts.Conducts clinical review meetings with physician office staff and internal staff.
Works in collaboration with the PC2 team on program review, evaluation and program design enhancements.Serves as the subject matter expert for primary care practices on all Anthem Care Management programs for all lines of business and care management programs (i.E.
CM, DM, Senior, Nurse Line).Partners with case/disease management departments to facilitate clinical processes between the company and provider offices Serves as a liaison with state / region provider contracting account managers and other associates.
The ideal candidate will have the following:RN with managed care experience.Experience conducting training and/or quality improvement activities.Auditing or site review experience.Clinic or physician office setting experience helps.Understanding of HEDIS, primary care standards, Title 22, CA Code of Regulations, Health and Safety Code, and other regulatory requirements.This position requires certification per Department of Health Care Services policy.
New hire will undergo rigorous Site Review Process training on audit tools and standards before undergoing certification process with an Anthem certified trainer.QualificationsRequires BA/BS in Nursing and minimum of 5 years of medical management experience; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted RN license required.
MS or advanced degree preferred.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.