Anthem, Inc. Mgd Care Coordinator in Fresno, California
SHIFT: Day Job
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.
Given Anthem’s scale, balance sheet, broad national reach and depth at the local market level, Anthem has established a new business unit called the Diversified Business Group. The Diversified Business Group is a solutions-oriented business unit within the Company that will support Anthem and other external clients in the pursuit of transforming healthcare.
MGD Care Coordinator
Location: Position based in Arkansas
Summary: Responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract. Responsible for performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination and management of member's program needs
Primary duties may include, but are not limited to:
Responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract.
Responsible for performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination and management of member's program needs.
Using tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high risk complications) and coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order to provide care coordination support.
The process does not involve clinical judgment. Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of services.
Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, and physicians. Identifies members that would benefit from expanded services.
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.
Qualifications - External
Requires a BA/BS in a health related field preferred; minimum of 1 year of experience working directly with people related to the specific program population or other related community based organizations; or any combination of education and experience, which would provide an equivalent background
Specific education and years and type of experience may be required based upon state law and contract requirements. Travel may be required. For MMP, requires Community Health Worker certification to be obtained within one year of employment.
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