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Clinical Quality Program Manager - Atlanta, GA PS5356

PS5356 Requisition #
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Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s 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. 

Clinical Quality Program Manager - Atlanta, GA PS5356

Responsible for serving as a liaison with and overseeing the quality improvement activities/projects/programs for one or more states within a major line of business. 

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. 
• Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is 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.

• 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 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 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.

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