Manager Case Management, Washington DC, # 137876

  • Company: Anthem
  • Location: Washington, District of Columbia
  • Posted: December 19, 2017
  • Reference ID: 1875016386
W hat 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 over 150,000 patients in eight 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 of one of America's largest managed healthcare organizations.

CareMore's Primary Care & Collaboration division oversees strategy, operations, and care delivery in our primary care markets (Iowa, Tennessee, Connecticut), where CareMore builds and runs capitated primary care medical groups and currently serves over 22,000 high-risk Medicaid and Medicare patients, as well as our collaboration with Emory Health System, which brings the CareMore model to over 20,000 Medicare Advantage patients in Georgia. The division also supports the development of new markets and models in the Primary Care & Collaboration area, including multiple new markets planned in 2018 and 2019. Our comprehensive approach to care includes extensivists managing acute and post-acute episodes of care, primary care clinicians, behavioral health clinicians, care management & engagement with case managers and community health workers, and mobile home-based care. We are continuing to evolve our model to effectively engage and care for complex patients and are building a team of passionate and execution-minded leaders dedicated to this mission.

You can learn more about CareMore's transformative approach to care here:

Des Moines Register - New Model: Insurers Hire Doctors

The Atlantic - The Quiet Healthcare Revolution

The New York Times - The High Price of Failing America's Costliest Patients

The Manager, Care Management & Engagement will be a founding member of the market leadership team and lead the buildout of initial and long-term market care management & engagement programs and teams. He/She is responsible for coordinating effective transitions of care and ambulatory care management, as well as total population & risk-based outreach and engagement and will directly lead the the team driving this work, including care managers, care coordinators, community engagement managers, and community health workers and lead holistic care planning and action around patients' medical, behavioral health, and social health needs across the care continuum. The Manager will report to the General Manager and have a dotted line to the Regional Medical Officer for clinical oversight and decision-making.

Core Competencies:

Excellent clinical acumen; a seasoned clinician and care manager who is passionate about driving individual and population outcomes

Experience building and leading care management and outreach programs & teams to success

A confident and supportive leader, collaborative team member, and effective communicator

Willingness to operate in an ambiguous environment, without continuous supervision

Understand the parameters and limitations of position responsibilities, know when to seek the direction of the clinical and operations leadership

Essential Duties & Responsibilities:

Build and lead care management & engagement for a large clinical enterprise caring for complex medical and BH patients

Accountable for establishing a patient-centered culture of doing 'whatever it takes' to improve patient health and achieving care management and engagement goals, including process and performance metrics

Ensure appropriate 24/7 coverage and that care management & engagement activities meet internal compliance, quality, and operational standards

Lead holistic engagement & care management across the continuum of care from initial outreach and relationship development, care planning, and follow-up alongside team members, patients, and other community resources to change the trajectory of outcomes

Highly organized and able to build structure for others; passion for clinical and operational excellence and continuous process improvement to enhance efficiency and effectiveness of care management & engagement

Effectively manage the care management & engagement team: care coordinators, community engagement managers, and community health workers by creating appropriate planning and analyzing variances from care plans, while initiating the appropriate steps to resolve variances across patients and team members

Demonstrated experience leading teams to success, including hiring, onboarding, coaching, and performance improvement of direct reports

Support Regional Medical Officer and General Manager in monitoring clinical, financial, and operational outcomes, and drive data-driven design & execution of care management & engagement initiatives to improve performance

Own and drive local market training and auditing, in concert with CareMore Center of Excellence (center for program design & fidelity) and Academy (center for learning & development)

"Roll-up your sleeves" attitude and ability to work in a start-up environment, including the ability to lead within ambiguous settings; strong team building, leadership, and communication skills; internal motivation and drive; and track record of delivering results.

Develop and manage relationships and shared work with health plan (Anthem/Amerigroup, others) and community partners (hospitals, ERs, SNFs, clinics) to improve effectiveness of engagement & care management

Work Location & Travel Expectations
Local market with local travel, with some regional travel to CareMore Headquarters in Cerritos, CA.

Minimum Qualifications

BA/BS in a health related field; current, unrestricted RN license in applicable state(s)

5 years of care management experience in progressive leadership roles; or any combination of education and experience, which would provide an equivalent background; certification as a Case Manager preferred

/ Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at // antheminc.com/careers // . 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: Manager Case Management, Washington DC, # 137876

Location: DC-Washington

Requisition ID: 137876

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