Description
SHIFT: Day Job
SCHEDULE: Full-time
Medical Policy Regional Coordinator Schedule: Monday-Friday; 8am-5pm (Work your own time zone) Location: Remote with 10% travel
Be part of an extraordinary team
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact?
Duties & Responsibilities Responsible for serving as the link and quality assurance mechanism between the Corporate Medical Policy PMO and regional plan operations. Primary duties may include, but are not limited to managing and assisting: - Assures enterprise objectives for timely implementation and risk management are met; assures regional requirements are represented in the development of enterprise policy. - Assures PMO activities are conducted to support the achievement of regional business plans objectives. - Oversees and tracks local/regional implementation of policy. - Identifies key local stakeholders in systems, medical management, provider relations, marketing, and government relations. - Establishes effective working relationships and communications processes. Demonstrating solutions and initiative with minimal supervision and oversight. - Identifies local issues and systems and operational issues, and oversees, supports, and conducts local training. - Manage processes and develop optimized solutions/efficiencies using technology to coordinate, track, report in areas that may include but not be limited to: Handling consultant Questionnaire's with Academic Medical Centers, physician groups, and state medical societies; Medical Policy & Technology Assessment Agenda and materials management, Independent appeals collection and reporting, department inquiry management, and other processes within the department dependent on changing resource needs. - Assist as needed and as expertise develops to manage, coordinate, facilitate and optimize the process for testing the MCG updates/customization UAT and go live (after business hours) testing for the enterprise. - Develop and optimize reports on department information using excel, access, and working with business partners for developing enterprise tools. - Contribute and as needed assist to oversee the content management in WCS, Anthems enterprise content management system and participate in department QA of uploads to internal and external websites. Assist as needed with health related social needs (HRSN) materials and publications internally and externally if needed.
Qualifications
Requirements - BA/BS degree in a related field and a minimum of 5 years related experience; or any combination of education and experience which would provide an equivalent background. - Ability to travel may be required at 10% to a local office for training or for committee in person meeting management.
Strongly Preferred - Prefer-background with collaborative teams and developing materials for external use. - Clinical background or demonstrated understanding of Anthem medical policies. - Ability to demonstrate proficiency with Microsoft office tools specifically technical expertise in excel. - Experience using pivot tables, formulas and linking information for reporting. Experience in analyzing and managing large volumes of information on a daily basis. - Self-motivated, results driven individual with a strong attention to detail and a demonstrated ability to independently focus and manage multiple complex and technical tasks in a fluid environment with minimal supervision and oversight. - Must also be willing to do repetitive tasks and processes and show ongoing drive for results with a sense of urgency. - Must be willing to do testing after the usual business hours once to twice a year.
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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
REQNUMBER: PS70543-Virginia
