Anthem, Inc Clinical Account Director Sr (RN Preferred) Southern California (PS26764) in Downey, California
Clinical Account Director Sr (RN Preferred) Southern California (PS26764)
Location: Los Angeles, California, United States
Requisition #: PS26764
Post Date: Aug 27, 2019
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 benefits companies and a Fortune Top 50 Company.
Location: May reside anywhere in Southern California and work from home office when not in the field. ( A significant amount of the work will be in the Southern CA market with more limited time spent in Northern CA)
The Clinical Account Director Sr. is responsible for collaborating with clinical and healthcare analytic leaders (internal and external) to refine, monitor, disseminate, and improve the performance results of Participating Medical Groups (PMGs) in the California Commercial HMO product.
Primary duties may include, but are not limited to:
Analyzes data and summarizes Participating Medical Group (PMG)/ Independent Practice Association (IPA) performance using summary statistical procedures.
Collaborates with clinical and healthcare analytic leaders to develop and refine performance evaluation metrics to assist in determining the drivers of health care costs for Delegated Participating Medical Groups (PMGs).
Meets with PMGs on a regularly scheduled basis to discuss and present performance reporting and metrics; and is responsible for implementing and closing any remediation measures when appropriate.
Develops and analyzes business performance reports (e.g. for encounter data, claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
Requires addressing ad hoc business issues and working in a highly matrixed environment to problem solve and create a final solution.
Builds effective relationships with internal and external stakeholders. Implements and integrates complex clinical programs using project management principles.
Identifies need for and develops new policies, procedures, or operational guidelines within clinical account management.
BS in Nursing or other health-related field; 10 years of related experience; or any combination of education and experience, which would provide an equivalent background. Advanced education preferred.
Current unrestricted RN license strongly preferred.
Experience in pay for performance or accountable care programs desirable.
Requires operational knowledge and subject matter expertise on a broad spectrum of medical/care management functions.
Understanding of medical group reimbursement models including ACOs is a plus.
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 careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.