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Manager CareMore Case Management, San Jose, PS5576 in San Jose, CA at Anthem, Inc.

Date Posted: 1/5/2019

Job Snapshot

Job Description

Your Talent. Our Vision.  At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it’s a powerful combination.  It’s 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 managing quality, cost effective care using selective benefits and alternative services best suited for the member. 

Responsible for assisting in developing and managing the implementation of clinical protocols and programs. 

Primary duties may include, but are not limited to: 
  • Manages quality improvement, resource management, cost containment, case management, and member and provider grievance resolution. 
  • Assists in developing and managing department policies and procedures, clinical data analysis, ancillary contract implementation, and provider education. 
  • Develops and implements corrective action plans. 
  • Assists in creating annual Case Management (CM) work plan, quarterly reports, and annual evaluations. 
  • Manages the implementation of CM programs and monitors and recommends modifications. 
  • Represents the Health Plan in vendor meetings. 
  • Attends case management meetings and medical management committees. 
  • Assists in developing and directing local physician education programs. 
  • Evaluates CM system/clinical operation effectiveness and presents findings to management. 
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports. 

  • Requires an LPN/LVN or RN; 4 years of experience; or any combination of education and experience, which would provide an equivalent background. BS in Nursing preferred. Current unrestricted PN/LVN or RN license in applicable state(s) required. For CareMore business units, satisfactory completion of a pre-placement Tuberculosis test is a requirement for this position.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.