Anthem, Inc. Clinical Quality Program Manager in Jefferson City, Missouri
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company
The Clinical Quality Program Manager is 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. Nursing License highly preferred.
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 and FHPS 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.
Implementation of new initiatives.
Leads interactions with enterprise partners or oversight entities.
Responsible for coordinating and completing HEDIS Quality Department specific projects within assigned state(s) ensuring consistency with company strategy, commitments, and goals.
Must have led a quality improvement team within a medical management department of a health plan for at least 3 years and organized quality improvement efforts with measurable and repeatable outcomes.
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. Minimum 2-3 years, experience with HEDIS and NCQA. Strong analytical skill set as well as strong verbal, written and interpersonal communication skills. Clinical quality background, auditor experience as well as NCQA or accreditation background. Current unrestricted license, certification in applicable field (i.e. CPHQ, CHCQM) and/or a MS in the health field (i.e. Nursing) is preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.