RVP Quality (Medicare)
DescriptionSHIFT: 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.
Title: RVP Quality (Medicare); Internal Title: (RVP Medicare Stars, QM/RA Perf))
Region: WI, IN, MO, TN, LA, GA, OH, KY, IA
Responsible for developing, coordinating, communicating, and implementing strategic clinical quality management and improvement program within a Medicare region. The RVP Quality is a direct report to the regional President and is responsible for quality for all Medicare products, leads directly and through corporate teams all revenue enhancement efforts (RAF score improvement) additional initiatives and acts as subject matter expert to the other Medicare regions. Responsible for attaining high-quality scores/Star ratings which can result in significant savings/revenue enhancement for the health plan.
Primary duties may include, but are not limited to:
- Promotes understanding, communication, and collaboration with enterprise-wide leaders to ensure appropriate communication, integration, and utilization of best practices.
- Oversees internal and state Quality Management (QM) Scorecard reporting.
- Provides oversight for the member complaint, appeal process, privacy compliance process, or auditing of delegated services in assigned area.
- Oversees Health Employer Data Information Sets (HEDIS) and/or CAHPS, including Value-Based Purchasing (VBP) programs.
- Develops strategic HEDIS, CAHPS, VBP goals, and objectives, ensures timely completion, and develops contingency plans as needed.
- Supports the External Quality Review Organization (EQRO) reporting and state audit processes.
- Provides leadership for QM representation in new business activities.
- Ensures compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies (as applicable).
- Leads regional and corporate QM committees and leadership meetings.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Requires a BA/BS in Business, Healthcare Administration or related field
- 12+ years of experience in health care environment;
- 10 years of experience in a managed care organization QM role;
- 8 years of experience working with government sponsored health care programs; or any combination of education and experience, which would provide an equivalent background.
- MS/MA in nursing, public health, healthcare administration, or other health care related field;
- 5+ years STARS and/or Risk Adjustment experience
- 8+ years Leadership experience with direct report responsibilities with large teams working both remotely and/or office-based
- Provider consulting experience utilizing data to drive conversations
- Experience presenting Quality, HEDIS, and STAR scores data to leadership
- 8 years of experience working with government-sponsored health care programs; or any combination of education and experience, which would provide an equivalent background
- Proven ability to improve star ratings and drive accountability through matrix partners
- 5+ years’ experience with provider coordination/engagement added this based on your notes.
- Certified Professional Healthcare Quality (CPHQ) 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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.
Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.