/This position is located in Chicago, Illinois/
Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, it's a powerful combination, and the foundation upon which we're creating access to greater 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.
Responsible for managing a team of clinicians charged with clinical quality management activities that ensure programs meet accreditation and regulatory standards, and to promote effective use of resources.
Primary duties may include, but are not limited to:
Oversee quality management activities performed by Clinical Informatics Team.
Day-to-day monitoring and prioritizing of workflows and activities. Develops and improves departmental processes and operations. Monitors goals, performance, and processes.
Performs audits to monitor efficiency and compliance with policies
Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
Effectively manages the resources to meet the departmental goals and deadlines,
Serves as a resource and a subject matter expert.
Other duties include:
Use of a clinical authoring tool to collaboratively codify clinical rules and implement evidence-based workflows
Performs Clinical QA of the pathways and workflow designs to ensure that clinical intent of the Guidelines and Medical policies is reflected accurately in the operational workflow.
Use additional tools and technologies (business rules engine, enterprise content management, and terminology management) to support workflow
Provide subject matter expertise to assist with integration of related processes
Provide on-going technical and clinical expertise to assure the consistent delivery of clinical knowledge and clinical decision support
Apply clinical information technology and clinical process improvement to support best clinical practices and standardization of care
Use and help meet deadlines in the software development life cycle methodology
Participate in and/or lead testing of clinical rules-clinical QA, UI, and acceptance testing
Work closely with key stakeholders to ensure appropriate changes in workflow
May assist in development of training materials for call center staff.
The qualified candidate will have:
Requires current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States, and 5 years acute care clinical experience or any combination of education and experience, which would provide an equivalent background.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Prior managerial experience is highly preferred
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 I Medical Management - AIM Chicago - 134603
Requisition ID: 134603
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