Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Office based in either Columbus OH Cleveland OH Lexington KY or Louisville KYResponsible for the fiscal, operational and regulatory management for a large and/or complex Health Plan and aligns strategy to achieve business goals. Primary duties may include but are not limited to:
- Manages the health plans P&L to include revenue, cost management, SG&A and forward-looking product growth opportunities.
- Oversees and participates in medical management, including hospital census review, medical staffing, seasonality issues, detailed communications with the medical director and nurse leader and monthly accrual analysis.
- Oversees and participates in the development of growth strategies and retention initiatives for the health plan.
- Oversees marketing and product growth strategies and business initiatives as well as school-based, faith-based, community-based and special needs initiatives.
- Manages relationships with key hospital, large physician practices/clinic and key ancillary providers such as dental and vision contractual relationships.
- Drives provider collaboration and engagement in the areas of service and Payment Innovation.
- Responsible for health plan budgeting and financials, including management of expenses, capital budget planning and management.
- Ensures compliance with CMS guidelines and HIPAA compliance, including securing and coordinating resources necessary for such compliance.
- Certifies monthly and quarterly financial statements, encounter reporting, quality audits, HEDIS/EPSDT and other required regulatory reports.
- Oversees risk management program, including fraud and abuse program compliance, and reporting responsibilities.
- Hires, trains, coaches, counsels and evaluates performance of direct reports.