Anthem Manager II HEDIS Quality Management Medicare - 128667 in Cerritos, California

/Your Talent. Our Vision/. AtAnthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.

Manager II HEDIS Quality Management (Medicare East Region) - 128667

This is a work from home position, however the selected candidate must reside in the Eastern Time Zone or Central Time Zone.

Responsibilities are positioned so they both contrast and are complementary with multi-plan QM leader responsibilities and inclusive of primary responsibility for managing HEDIS Medical Record Review activities year round and as part of defined HEDIS season. HEDIS responsibilities incorporate ownership of managing quality data and interventions for defined markets and identifying opportunities to impact HEDIS Star measures, developing programs and initiatives, creating action plans and execution. Role incorporates oversight of HEDIS process with vendors and inclusive of HCC components tied to provider collaboration and revenue enhancement. Serves as key point of contact for operational activities related to vendors and with corporate quality and finance teams. Oversees HEDIS Medical Record Review collection and project performance for markets in the East Region for Medicare.

Primary duties may include, but are not limited to:

  • Establishes Quality Management objectives and annual goals.

  • Develops and submits and analyzes dashboard reports for all markets, analyzes validity of quality management data/reports from a clinical perspective.

  • Coordinates development, implementation, and evaluation of quality improvement action plans as it relates to HEDIS.

  • Provides oversight and ensures implementation of the Healthcare Effectiveness Data Information Set (HEDIS) data management and reporting strategy; coordinates the related improvement action plans and reports up to leadership on outcomes and project management.

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

    Requires a BA/BS in a health or business related field; • 7 years of experience in a healthcare environment, • Prior experience managing a team of direct reports with; or any combination of education and experience, which would provide an equivalent background. • 3 years of HEDIS project management experience is required. • Experience with QSHR is preferred. • MSN, MPH, or MPA preferred. • Current clinical license preferred. • Proficiency in MS Office, specifically Excel and Access is preferred. • Ability to travel approx. 30% domestic with some overnight stays is required.

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/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./

Job Medical

Title: Manager II HEDIS Quality Management Medicare - 128667

Location: CA-Cerritos

Requisition ID: 128667