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Practice Consultant – California Required

Anthem

This is a Full-time position in Los Angeles, CA posted June 11, 2022.

Your 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 care companies and a Fortune Top 50 Company.This position will be supporting our Commercial HMO market in the state of California. Responsible for creating a partnership relationship with providers and other initiatives and implementing the concept of a Medical Home for our members to achieve this fully integrated and accountable system of care. Primary duties may include, but are not limited to: Provide guidance to and oversight of PMGs that provide services to Anthem CA Commercial HMO membership as a key participant of JOCs; Gather and analyze PMG performance measures and perform root cause analysis for indicators falling below desired performance; Provide a feedback mechanism for communicating findings, recommendations, and a plan for implementing corrective action (when necessary) related to PMG performance; Report recommended actions to address any identified opportunities for improvement to the Anthem Provider Performance Advisory Committee (PPAC); Work cross functionally within Anthem’s highly matrixed organization to ensure that all gaps regarding PMG performance are resolved; Recommend continuation or termination of the PMG delegation arrangement to PPAC; Identify any other PMG trends or behavior that should be addressed in order to mitigate Anthem risk; Collaborate with Anthem CA market leaders to help define local market strategy, best practices, and cost saving opportunities; Perform any other job related instructions, as requested. Requires an AS/BS in nursing; 5 years of managed care experience; 3-5 years of clinical experience; 2 years of professional presentations to small and large audiences; 3 years of healthcare data analysis; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in the state of CA required. Experience with CA’s delegated model and its oversight strongly preferred. Knowledge of HMO plans storngly preferred. Experience with compliance and regulatory audits strongly preferred. Experience with relational databases and knowledge of query tools and statistical software is required – SQL, Access, and Excel required. Ability to manipulate large sets of data required. Strong communication, analytical, organizational and problem solving skills. 40%-50% travel in Southern California required.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.