Manager Clinical Quality
DescriptionSHIFT: Day Job
Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, 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.
We are hiring a Manager Clinical Quality. Responsible for managing the day-to-day activities and all aspects of clinical quality program components which may be related auditing for URAC/NCQA accreditation requirements, regulatory/compliance requirements and/or other quality assurance related activities.
Primary duties may include, but are not limited to:
- Implements and evaluates current processes including operational statistics, service standards and process improvement initiatives. Identifies opportunities for improvement
- Serves as Point of Contact with Training Department to drive quality improvements for clinical operations documentation and processes
- Provides oversight in the planning, implementation and coordination of health care audits to ensure high quality, cost effective care.
- Participates in internal and external quality review activities.
- Manages and oversees quality assurance activities, which may include, but is not limited to: managing the production, analysis, and submission of audit results; coordinating audit activities which support both URAC and NCQA accreditation requirements; and regulatory/compliance requirements
- Develops employee productivity standards
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
Requires BS in nursing or a health care related field and minimum of 3 years of managed care experience which includes a minimum of 2 years supervisory experience; or any combination of education and experience, which would provide an equivalent background.
Experience in program development and knowledge of the quality process and QI techniques strongly preferred.
MS in nursing or related clinical field and CPHQ preferred.
Certification and/or license appropriate to field of specialty as required.
Utilization management experience 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.