, Massachusetts

Description

SHIFT: Day Job

SCHEDULE: Full-time

Medical Policy Regional Coordinator-OMPTA (550090)

Responsible for serving as a liaison and quality resource between The Office of Medical Policy and Technology Assessment (OMPTA) and multiple regional/health plan business operation areas for the enterprise and all lines of business. Primary duties may include, but are not limited to managing or assisting with the management of the following:

  1. Assures through OMPTA activities that enterprise objectives for timely implementation, compliance, and risk management are met and the information is considered in the development and publication of enterprise policies.  Oversees and tracks issues related to the implementation of documents by OMPTA and identifies means to remediate issues.
  2. Lead/manage ongoing work streams/projects including facilitating, coordinating meetings, agendas, materials, minutes for at least one clinical and/or business committee.  Track meeting actions and outcomes. 
  3. Identify key stakeholders (medical management, provider relations, legal, regulatory, compliance, IngenioRx, Aim and other areas)  and establish strong working relationships and communication/collaboration processes across the stakeholder and enterprise business areas relaying key information in an accurately and timely manner.
  4. Duties also include but are not limited to:
    1. Data collection, analysis, entry and maintenance-use of access databases, excel, and department Document management system (DMS);
    2. Work with External independent clinical appeal review, entry, and track/trend reporting related to the overturn information related OMPTA documents;
    3. Contributes and works with documents content from WORD to HTML through Anthem’s enterprise content management system and participate in department QA of uploads to internal and external websites.
    4. Inquiries-Research, respond, track, trend inquiries related to OMPTA documents in coordination with the research team accurately and timely.

Qualifications

  • Requires a BA/BS in a related field; 5 years of related experience; or any combination of education and experience, which would provide an equivalent background.
  • RN preferred.   
  • Must be proficient with Word and Excel with demonstrated ability to utilize Microsoft office tools to analyze and manage large volumes of information on a daily basis. 
  • Experience in analyzing data and in conducting audits to identify patterns and trends and overseeing corrective action plans in a quality or clinical environment.  
  • Experience with editing document content and highly complex medical information and/or quality or regulatory processes is required.  Anthem medical policy experience is strongly preferred.  
  • Demonstrated ability to communicate clearly both verbally and in writing with different audiences and levels on complex subjects. 
  • Task oriented individual with a strong attention to detail and a demonstrated ability to independently focus and manage multiple complex projects and technical tasks in a fluid environment. 
  •  Ability to travel if needed.

Prefer individual in the Northeast (ME, NH, CT, MA, VT, RI, NY) for ease in travel to the Portland, Maine office for training/collaboration with other team members as needed.  Individuals outside of the preferred locations may apply but need to be willing to travel as needed.  Full time W@H as part of the evolving hybrid work model is an option with access to an office for training and collaboration.

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.

, Massachusetts

As one of America’s largest health benefits companies, we at Anthem have a profound appreciation for service. Our organization proudly supports our Nation’s active, reserve, and veteran military service members and their spouses.

This is an exciting opportunity to advance your life and career, while still protecting and serving others. Come see for yourself why Anthem is recognized as a Top Employer by GI Jobs and among the “Best of the Best: Top Veteran Friendly Companies” by US Veterans Magazine.

Who We Are Looking For 

Anthem, Inc. is seeking military veterans across the country who bring a deeply rooted skillset that includes team-oriented approaches to problem-solving, demonstrations of leadership and an overall commitment to the mission of the organization.  If you are a military veteran or military veteran spouse, Anthem, Inc. is looking to hire you.

Join Anthem's Military and Veteran Talent Network: https://anthemcareers.ttcportals.com/pages/military

Should I Apply?

Are you a transitioning member of the military or a military veteran who is looking for a civilian career that provides opportunities for growth and career advancement?  Anthem, Inc. is currently looking for job seekers with  Operations experience.  If you are interested in a career in one of these fields, check out our current open positions to the right for more information and to apply today!

What Happens After I Apply?

Once you click ‘Apply Now’ on an Anthem, Inc. job posting, you will be re-directed to fill out an application on Anthem's career page.  In order to be considered for next steps, please complete the application on Anthem's career page and make sure you have an updated resume uploaded to your RecruitMilitary profile.  Once Anthem, Inc. reviews your resume and profile, a recruiter will reach out to provide you with more information and to schedule you for an interview.

How to Win An Interview

1.     Review the job description for the specific position you are applying for.

2.     Review the company website. Know their mission and values. What do they do? What are their products?

3.     Prepare a few questions to ask on your interview.

4.     Prepare to discuss your military or civilian background and how it relates to the position. 

5.     Check out our Resources tab for resume guidance, interview prep and more!

Similar jobs