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Clin Qual Prog Manager - Must reside in California, Texas, or Colorado (PS13329) in San Diego, CA at Anthem, Inc.

Date Posted: 11/2/2018

Job Snapshot

  • Employee Type:
  • Location:
    San Diego, CA
  • Job Type:
  • Experience:
    At least 4 year(s)
  • Date Posted:

Job Description

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 benefits companies and a Fortune Top 50 Company. 

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.

Serves as a primary contact with providers for engagement in all quality and revenue initiatives including HEDIS, CMS STARs, Risk Adjustment, CAHPS/HOS, coding and documentation.   Manages Medicare Advantage quality improvement activities for provider groups in the West Region, focusing on CA, TX, or CO.

Primary duties may include, but are not limited to:
  • Developing and maintaining provider work plans for improved quality of care outcomes.
  • Organizing and facilitating monthly and quarterly meetings with providers as well as Joint Operating Committees (JOCs) and interim contact as required. 
  • Collaboration with associated Anthem teams to reach overall member quality goals and metrics
  • 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.
  • Assists team members according to individual knowledge and skills.
  • 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 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.  Must have strong presentation skills. Travel (local and overnight) up to 50%.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.


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