Clinical Quality Program Manager (HEDIS Experience Preferred)
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.
We are hiring a Clinical Quality Program Manager for North Carolina Medicaid. 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.
- Understanding of detailed quality-related specification requirements such as metric specifications or accreditation standards
- Experience working in managed care with in-depth experience understanding measurement specifications; managed care HEDIS data sets a plus
- Advanced Excel skills with ability to sort medium size data sets, identify trends and place analysis in table or graphic format with an explanation
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.