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 driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan.
- Directs and provides leadership for implementing, monitoring and evaluating the Quality Management Program for the health plan.
- Promotes understanding, communication, and coordination of the quality management program.
- Directs and provides leadership for compliance with National Committee for Quality Assurance (NCQA) standards.
- Provides leadership for the interpretation of results and development of improvement action plans arising from provider and member satisfaction surveys.
- Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.
- Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year round medical record review, and over read processes.
- Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Requires a BA/BS in a health or business related field; 8 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background. MSN, MPH, or MPA preferred. Current clinical license preferred. CQM experience in a Managed Care Organization preferred.
*WARNING : Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies. Please be advised that an Anthem recruiter will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for a role with our company. All of our careers require that you first complete an online application.