Job details
Job type full-time
Full job description
Description
Shift: day job
Schedule: full-time
Your talentOur visionAt caremore, a proud member of the anthem, incFamily of companies, it’s a powerful combinationIt’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communitiesJoin us and together we will drive the future of health care.
Caremore is a proven care delivery model for the highest-riskWe are a team of committed clinicians and business leaders passionate about transforming american healthcare deliveryWe build and lead integrated, multi-disciplinary clinical teams to care for the most complex patientsWe strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experienceAs an anthem subsidiary, we benefit from the scale and resources one of america’s largest managed healthcare organizations.
Caremore`s delegation management and oversight (dmo) team is accountable for the oversight and management of functions delegated to caremore which includes credentialing, claims, utilization management and case managment.
Primary duties for this managing level position, with moderate to advanced complexity and broad/enterprise scale may include, but are not limited to:
Manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments.
Audit planning, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
Establish gap analysis, milestone dates, and other significant aspects, and leadership updates.
Maintain knowledge of laws, regulations, company strategies to assess impact, and consult with clients as subject matter expert.
Conducts complex investigations, document findings, and ensure corrective actions are made.
Interface with external clients, regulators, vendors, supplier; internal stakeholders, high level of management.
Qualifications
Minimum qualifications:
Requires a ba/bs and minimum of 6 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent backgroundAbility to work from home.
Preferred qualifications:
Ms/mba/jd or professional designation preferred.
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.
Anthem, incHas been named as a fortune 100 best companies to work for®, is ranked as one of the 2020 world’s most admired companies among health insurers by fortune magazine, and a 2020 america’s best employers for diversity by forbesTo learn more about our company and apply, please visit us at careers.antheminc.comAn equal opportunity employer/disability/veteranAnthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all anthem positions.
