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Manager Clinical Quality

Location: NC
JobFamily: Medical
Req #: PS66836
Date Posted: Apr 14, 2022

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SHIFT: Day Job

SCHEDULE: Full-time

Manager Clinical Quality - North Carolina 

**$5,000 Sign On Bonus**

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 Manager Clinical Quality in North Carolina. Responsible for managing the day-to-day activities of one or more clinical quality program components which may be related to HEDIS reporting, NCQA accreditation and/or other quality assurance related activities.

**$5,000 Sign On Bonus**

Primary duties may include, but are not limited to:

•         Implements and evaluates current processes including operational statistics, service standards and process improvement initiatives.

•         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 the annual HEDIS report; overseeing community health promotion and disease management initiatives in each state in the region; coordinating audit activities with other regions; managing achievement and maintenance of NCQA accreditation; scheduling all information for surveys, conducting mock audits, and providing consultation to business units and team leads as regards NCQA standard issues.

•         Hires, trains, coaches, counsels, and evaluates performance of direct reports.


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.

Up to 10% overnight travel. 

Must reside in North Carolina or within 50 miles of the North Carolina border

Position will be hybrid, up to 50% field-based.

Preferred Qualifications

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.

At least 4 years working in managed care quality as a program manage or manager of people

Must have in-depth knowledge of NCQA HEDIS measure specifications

Clinical license 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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. 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.

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 Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

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.