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Clinical Program Consultant - AIM Chicago - PS5268 in Chicago, IL at Anthem, Inc.

Date Posted: 12/7/2018

Job Snapshot

  • Employee Type:
  • Location:
    Chicago, IL
  • Job Type:
  • Experience:
    At least 5 year(s)
  • Date Posted:

Job Description

This position is located in our Chicago Corporate office (near O'Hare Airport).
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. 
Responsible for providing clinical program and project support in a Medical Management department. Primary duties may include, but are not limited to: Develop and implement clinical program execution for the management of members with cancer. Serves as key resource and leader for clinical implementation of medical management initiatives, such as clinical program implementation, development of policies and procedures, development and implementation of training procedures/processes, and participate in process improvement strategies. Oversees oncology drug-related medical policy implementation. Represents the department on enterprise-wide and regional committees and program initiatives. Requires a BS in nursing or related medical management area; 5 years of project/program management experience; or any combination of education and experience, which would provide an equivalent background. 

Other duties include:
  • Development of oncology drug-related clinical algorithms to collaboratively codify clinical rules and implement evidence-based workflows
  • Use additional tools and technologies (coding resources, enterprise content management, and terminology management) to support clinical system execution
  • Provide subject matter expertise to assist with integration of related processes
  • Use a clinical perspective to serve as a liaison to internal and external clinicians, including physicians, nurses, pharmacists and ancillary staff to execute assigned projects
  • Support analysis of interaction between cancer treatment pathway regimens and drug-specific coverage determination language
  • Provide on-going technical and oncology clinical expertise to assure the consistent delivery of clinical knowledge and clinical policy execution
  • Support clinical content vendor relationship and integration efforts
  • Apply clinical information technology and clinical process improvement to support best clinical practices and standardization of care
  • Requires familiarity with standard medical coding schemes (ICD-10, HCPCS, CPT-4)
  • Participate in and/or lead testing of clinical rules—clinical QA, UI, and acceptance testing
  • Adhere to best practices in clinical authoring and IT
  • Work closely with key stakeholders to ensure appropriate changes in workflow
  • Support call center staff on changes to oncology content and clinical process
The qualified candidate will have:
  • R.N. or B.S.N. nursing or related medical management area required
  • 5 years of project/program management experience, or any combination of education and experience, which would provide an equivalent background  
  • Requires basic oncology familiarity, including drug names and clinical comprehension
  • Minimum of 5 years of clinical practice preferred
  • Familiarity with Medicare and/or Medicaid clinical processes and/or programs preferred
  • Contact center experience preferred
  • Familiarity with Microsoft Word, Excel, and Visio
  • AIM experience by either internal AIM experience or exposure to AIM processes and clinical review programs, preferred
  • Informatics background helpful
  • Ability to manage multiple projects simultaneously
  • Analytical understanding of clinical work processes
  • Keen attention to detail
  • Listens well and influences decisions through written and verbal communication
  • Lead meetings effectively
  • Comply with corporate and departmental policies and procedures
  • Willing to work additional hours as needed
  • Adhere to AIM’s code of conduct
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 

An Equal Opportunity Employer/Disability/Veteran