Job Details

Dir Medicare Adv MA/Duals

Company name
Anthem, Inc.

San Jose, CA

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Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 40 million medical members nationwide. 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.  Responsible for the management, strategy and execution of both Medicare and Medicaid covered benefits, complicated contractual relationships with providers, growth and retention strategies, and close management of clinical initiatives for an assigned region. Primary duties may include, but are not limited to:
 Account management of critical groups and hospitals, retention and membership growth, and management of long term support services with providers and clinical teams.  Develop and execute upon Cost of Care initiatives and initiatives that impact member risk scores and plan revenue. Ongoing management of local and Federal regulators.  Manages and oversees ongoing work that is specific to maintaining contractual obligations of our 3-way contract.  Champions initiatives by developing and managing State rate negotiations and key relationships with government, regulatory, Medicare/MMP and other stakeholders as appropriate.  Provides coordinated analysis and regional solutions to issues. Guides implementation of programs and strategies.  Collaborates with senior management to develop and implement new programs to enhance relationships with key stakeholders and to promote programs and services.  Collaborates with Marketing Management to develop marketing strategies for member recruitment and retention for all assigned lines of business.  Directs strategic planning on marketing, clinical programs, network maintenance and development and program advocacy in assigned area.  Resolves programmatic challenges related to program operations including member issues, provider claims and provider network. Manages projects and issues across departmental and divisional lines to facilitate timely resolution.  Represents business unit on national/state/regional boards, task forces, and work groups that impact the health care delivery system and other key health care issues.  Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Job Requirements

Requires a BA/BS in a related field; 8 years management experience in the health care field and either or specific contract negotiation experience in both provider network management and state rate contracting or clinical management; or any combination of education and experience, which would provide an equivalent background. Master's degree or clinical licensed preferred. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.

Company info

Anthem, Inc.
Website :

Company Profile
The company was formed when WellPoint Health Networks Inc. and Anthem, Inc. merged in 2004 to become the nation's leading health benefits company. The parent company originally assumed the WellPoint, Inc. name at the time of the merger. In December 2014, WellPoint, Inc. changed its corporate name to Anthem, Inc. The Anthem brand is built on a foundation of trust – it’s the name consumers are most familiar with as a trusted health care partner through our affiliated health plans. Anthem, Inc. is one of the largest health benefits companies in the United States. Through its affiliated health plans, Anthem companies deliver a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Headquartered in Indianapolis, Indiana, Anthem, Inc. is an independent licensee of the Blue Cross and Blue Shield Association serving members in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin; and specialty plan members in other states.

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