Anthem RVP Clinical Accountability-MD (3 openings) -PS2001 in Augusta, Georgia

These positions will help lead a new Governance Structure for clinical UM and CM work, to ensure consistent/standardized, efficient and effective clinical operations throughout the enterprise. This will be accomplished byfinding metric variation and the associated root causes and then working with local health plans to resolve unexplained variation in each region. Consistency and efficiency across all lines of business will drive improvement in key Financial Operating Performance metrics while providing the appropriate level of care for our members. It is also the responsibility of this position to work closely with the finance and transformation governance committees to ensure shared interests are coordinated and optimized.

Additionally, the successful candidates will be responsible to:

  • Develop and drive execution of P&Ps throughout the local health plans promoting best practice identification and deployment
  • Aligned key metrics, efficient use of resources and process and financial improvements
  • Develop dashboard/metrics that depict efficiency and effectiveness of our clinical programs
  • Identify and drive WAVE improvement initiatives specific to UM CM clinical processes, including cost savings tied to implementing standardization
  • Create specific focus on IP UM (do the basics better) to drive improved IP UM metrics and CM initiatives that can aid in reducing utilization costs and improving member outcomes
  • Set specific measureable targets for improvement in key clinical process metrics
  • Manage clinical process exception/escalation process and Clinical Process Governance forums
  • Lead executive, stakeholder, and organization communication of vision, strategy, operational plans and performance
  • Each position will be assigned to a business segment leader (i.e. Medicare, Medicaid, or Commercial)
  • Responsible for ensuring consistent/standardized, efficient and effective clinical Utilization Management (UM) and Case Management (CM) operations for a region.
  • Customizes and drives execution of policies and procedures throughout local health plans promoting best practice identification and deployment.
  • Develops dashboards/metrics that depict efficiency and effectiveness of clinical programs. Participates in developing training materials.
  • Identifies and drives improvement initiatives specific to utilization management and case management clinical processes, including clinical performance management savings.
  • Creates a specific focus on Inpatient utilization management (IP UM) to drive improved IP UM metrics and CM initiatives to support utilization reduction and improved member outcomes.
  • Sets specific measurable targets for improvement in key clinical process metrics within region and in alignment with enterprise strategy.
  • Assists local markets in developing action plans.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

  • Requires M.D. or D.O.; board certification approved by the American Board of Medical Specialties where applicable to duties being performed; must possess an active unrestricted medical license to practice medicine or a health profession in a state or territory of the United States. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
  • Preferred experience in primary care, internal medicine or family practice
  • Requires knowledge of regulatory and accreditation agencies and requirements, as well as medical, quality improvement and utilization management practices in a managed care environment
  • Minimum of 10 years clinical practice experience and at least 10 years Leadership/medical management experience including leadership and deep understanding of market-level UM and CM programs;or any combination of education and experience, which would provide an equivalent background.
  • Demonstrated experience in leading market level UM and Case/Disease management programs
  • Expertise and knowledge in Medicare, Medicaid, or Commercial business strongly preferred
  • Experience leading large national or regional medical expense initiatives
  • Knowledge of Quality, (HEDIS) programs
  • Prior experience analyzing data and identifying drivers of medical cost trends and implementing initiatives to mitigate trends
  • Strong business acumen
  • Demonstrated history of being an agent of change and team builder, with high integrity
  • Ability to lead multi-functional team while maintaining focus on priorities, in a fast paced environment with an emphasis on delivering under tight deadlines
  • Demonstrated superior oral, written, and interpersonal communication, persuasion, and negotiation skills
  • Excellent analytical ability, strategic planning, organization, project management, and leadership skills
  • Ability to successfully interface at all levels with the customer, industry, and corporate interfaces
  • Strong leadership, change management, coaching, and staff development skills
  • Good listener and strong relationship builder

*Positions are location independent though helpful to be near a major airport, and will require 50% travel.

/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./

Job Medical

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: RVP Clinical Accountability-MD (3 openings) -PS2001

Location: georgia-Augusta

Requisition ID: PS2001