Your Talent. Our Vision. At Anthem Blue Cross and Blue Shield, a proud member of the Anthem, Inc. family of companies, 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.
Mgr. II Grievance and Appeals - In the Office of any one of the following offices: Denver, CO; Mason, OH; Midland, GA; Norfolk, VA; Virginia Beach, VA; Richmond, VA or Louisville, KY.
Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements. Lead a staff dedicated to resolving appeals and grievances specific to Behavioral Health services and therefore requires additional expertise. Primary duties may include, but are not limited to:
Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.
Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.
Addresses both internal/external customer/provider needs and concerns related to team activities.
Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Serves as a subject matter expert for team and works on projects impacting development, interpretation, and implementation of medical policy or other managed care initiatives that may cross functional lines or states.
Requires 5 + years grievance & appeals experience and 3-5 years of management experience including people managing and inventory managing in the healthcare industry; or any combination of education and experience, which would provide an equivalent background. BA/BS preferred.
Current or previously licensed as a Licensed Clinical Social Worker, Marriage and Family Therapist, Clinical Psychologist, Licensed Professional Counselor or RN license to practice as a health care professional within scope of licensure in applicable state(s) or territory of the United States strongly preferred.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Previous managed care experience preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.