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Manager II GBD Quality Management- Plan HEDIS/Health Promotions Atlanta, GA PS11700

PS11700 Requisition #
Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies, it’s a power combination.  We are focused on serving Medicaid, Medicare and uninsured individuals it’s 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. 

Manager II GBD Quality Management- Plan HEDIS/Health Promotions  Atlanta, GA PS11700

Work Location: Atlanta, GA

Responsible for developing and ensuring effective coordination of quality initiatives within the health plan, to include indicators for monitoring and evaluating the quality of care, service, and satisfaction of providers and members. 

Primary duties may include, but are not limited to: 
• Establishes Quality Management and Health Promotion objectives and annual goals. 
• Develops and submits dashboard reports for all state, Centers for Medicare and Medicaid Services (CMS), and accrediting measures; analyzes validity of quality management data/reports from a clinical perspective. 
• Coordinates development, implementation, and evaluation of quality improvement action plans. 
• Provides oversight and ensures implementation of the Healthcare Effectiveness Data Information Set (HEDIS) data management and reporting strategy; coordinates the related improvement action plans. 
• Provides training and education to meet National Committee for Quality Assurance (NCQA) standards. 
• Manage external practice facing relationships and internal relationships with Provider Solutions  leadership, Medical Directors and Health Care Delivery Systems (HCDS) leadership. 
• Ensures appropriate program tracking and performance reporting data for respective markets. 
• Develop and  deploy tools, resources and documentation to support Health Promotion/Quality Management programs and the tracking/reporting of the program successes.
• Provides primary oversight and direction of the Health Promotion Consultants in their assigned regions of Georgia.  (Some travel required within the state)
• 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, including prior management experience; or any combination of education and experience, which would provide an equivalent background. 
• 5+ years leadership/management strongly preferred.
• Requires HEDIS knowledge and experience. 5+ years HEDIS experience preferred.
• Must have excellent communication skills (written and verbal), interpersonal skills, project management and organizational skills.
• Requires exceptional networking & negotiations skills, and strong public speaking/presentation skill, and previous consumer marketing and/or grassroots/community outreach experience
• Proficient MS Word, Excel, Outlook, and PowerPoint.

• RN or LPN 
• Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT)
• Lean Six Sigma Training (Green Belt or Black Belt)
• Certified Professional in Healthcare Quality (CPHQ)
• Population health management and/or clinical quality program development experience preferred.
• Experience working with HEDIS, EPSDT, medical record audit or review.
• HEDIS project management experience
• Experience with Quality Improvement and Corrective Action plans.
• Experience working in a health insurance company or Medicaid, Managed Care setting.
• Experience with Inovalon software - QSHR 
• Strong strategic thinking and analytical skills; excellent organizational, presentation, and problem solving skills.        
• Candidate must be task and project-oriented with an excellent sense of priority, logic and objectivity. 
• Seeks out opportunities for process improvements/efficiencies, and supports business initiatives.

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.

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Customer care associates focus on becoming the ultimate consumer advocate. Share your expertise and help maximize the value of the tools and resources we provide. We're improving the consumer experience. Join us as we create a simpler, more affordable, more accessible healthcare system.

Customer care associates at Anthem:

  • Take ownership and resolve issues with care and concern
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  • Show initiative and resourcefulness in solving problems and meeting consumer needs
  • Develop relationships with other business units and service partners whose assistance, cooperation and support may be needed
  • Demonstrate empathy, exceptional written and verbal communication skills, and the ability to properly tailor assistance to a consumer's level of experience and knowledge

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