Director, Case Management

Anthem   •  

Phoenix, AZ

Industry: Manufacturing


8 - 10 years

Posted 62 days ago

This job is no longer available.

What Is CareMore?

CareMore is entering a new growth phase, as a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients and currently serve nearly 200,000 patients in multiple states across Medicare, Medicaid, and commercial populations. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.

CareMore’s Health Networks, Primary Care+, Touch and CareMore@Home models drive strategy, operations, and care delivery in our national markets (Arizona, California, Colorado, Connecticut, Iowa, Nevada, New York, Tennessee, Texas, Virginia and the District of Columbia), where CareMore builds and runs capitated primary care medical groups, at-risk health networks and upstream care delivery products in service of high-risk Medicaid, Medicare and commercial patients, and our collaboration with Emory Health System in Georgia. Our comprehensive, upstream approach to health is led by robust multidisciplinary teams of extensivists (managing acute and post-acute episodes of care), primary care clinicians, behavioral health clinicians, care management & engagement specialists (including social workers, case managers and community health workers), and mobile home-based care teams. We continue to evolve our model to effectively engage and care for complex patients, led by a team of passionate, execution-minded leaders dedicated to this mission.

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Responsible for overseeing CareMore case management operations and expansions among multiple states.
Primary duties may include, but are not limited to:

  • Oversees and directs the quality of care for high risk patients.
  • Implements strategies and oversees daily operations for Case Management, Transitions of Care and Utilization Management.
  • Leads regional care management activities and functions and ensures consistent delivery across all regional locations.
  • Serves as the subject matter expert and assists in the development and implementation of new programs and lines of business.
  • Develops programmatic approaches to new and existing programs.
  • Supports and implements initiatives to support growth and strategic objectives.
  • Develops and executes a performance strategy for the assigned region.
  • Oversees quality assurance.
  • Collaborates with neighborhood team, primary care physicians, specialists, and outside vendors; leverages all resources included in the clinical model.
  • Researches and develops new and innovative approaches to Case Management.
  • Partners with market leaders, Extensivists, Regional Medical Officers, and Senior Medical Officers to deliver high quality of life and care to frail patients.
  • Manages the annual budget.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

QualificationsRequires a BS in Nursing or related health care field; 8 years of experience including prior management experience in a health care environment (i.e. acute care); or any combination of education and experience, which would provide an equivalent background.