Dir I Medical Mgmt
WellPoint - Atlanta, GA

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Responsible leading multiple teams of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Primary duties may include, but are not limited to: Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. Manages areas which may include utilization management, case management, disease management and demand management. May also manage appeals for services denied. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Requires a BS in nursing or related health care fields, 5 years of experience in a health care environment (i.e. acute care) including management experience; or any combination of education and experience, which would provide an equivalent background. MS or advanced degree in a clinical nursing specialty, business or healthcare-related field preferred. Current unrestricted RN license in applicable state(s) preferred.Responsible leading multiple teams of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Primary duties may include, but are not limited to: Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. Manages areas which may include utilization management, case management, disease management and demand management. May also manage appeals for services denied. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Requires a BS in nursing or related health care fields, 5 years of experience in a health care environment (i.e. acute care) including management experience; or any combination of education and experience, which would provide an equivalent background. MS or advanced degree in a clinical nursing specialty, business or healthcare-related field preferred. Current unrestricted RN license in applicable state(s) preferred.
WellPoint - 17 months ago - save job
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We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best. As our companies continue to take a more...