Anthem Clinical Quality Program Manager - HEDIS Experience - (Medicare Central Region) 132493 in West Covina, California

/ 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.

Location: May be located in any of the Anthem Medicare Central Region states - KY, OH, IN, MO, WI, TN, or GA.

Responsible for serving as a liaison with and overseeing the quality improvement activities/projects/programs for one or more states for Medicare Advantage Business for Central Region . Primary duties may include, but are not limited to:

  • Leads state level quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process.
  • Works with the clinical intervention team to design studies to identify barriers to medical interventions.
  • Ensures that study methodology is sound and appropriate reporting is in place.
  • Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members.
  • Assures compliance with corporate QI work plans.
  • Assures that all QI activities are relevant to the needs of targeted population.
  • Maintains effective documentation of research programs to meet regulatory and Accreditation Standards.
  • Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of data analysis results.
  • Participates in and provides input to the development of new product designs for major line of business.
  • Oversees the implementation of new initiatives.
  • Leads interactions with regulators or oversight entities.
  • Oversees quality improvement activities for the largest, most complex state programs.

Requires a BS in health administration, nursing, or a related clinical field; 4 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background. Must have HEDIS experience. Willing and able to travel for provider office visits (approximately 25%).

Preferred

  • Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing).
  • HEDIS experience specifically with proven rate improvement results.
  • Project management experience leading and managing projects.
  • HEDIS specific software knowledge and experience.

/ 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 antheminc.com/careers. EOE. M/F/Disability/Veteran. /

Job Medical

Title: Clinical Quality Program Manager - HEDIS Experience - (Medicare Central Region) 132493

Location: california-West Covina

Other Locations: OH-Lima, Wisconsin, KY-Hopkinsville, OH-Cincinnati, IN-Fort Wayne, OH-Columbus, IN-Evansville, IN-Merrillville, OH-Toledo, OH-Youngstown, IN-Indianapolis, WI-Madison, GA-Midland, Kentucky, KY-Bowling Green, MO-Springfield, Indiana, KY-Lexington, KY-Louisville, TN-Kingston, IN-Mishawaka, TN-Knoxville, Ohio, OH-Seven Hills, TN-Bristol, TN-Memphis, MO-Columbia, MO-Jefferson City, OH-Akron, MO-Cape Girardeau, MO-St. Louis, KY-Shelbyville, OH-Miamisburg, OH-Worthington, OH-Canton, OH-Mason, WI-Eau Claire, TN-Kingsport, KY-Somerset, WI-Milwaukee, OH-Cleveland, TN-Chattanooga, TN-Johnson City, WI-Green Bay, WI-Fond Du Lac, GA-Atlanta, Georgia, WI-Waukesha, GA-Gainesville, GA-Macon, GA-Savannah, GA-Augusta, GA-Columbus, Tennessee, TN-Nashville, Missouri, TN-Louden, WI-Pewaukee, GA-Stockbridge

Requisition ID: 132493