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Clinical Quality (Medicaid) Program Manager - Behavioral Health - Colorado Springs, CO (139016) in Colorado Springs, CO at Anthem, Inc.

Date Posted: 2/13/2018

Job Snapshot

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.

Location: Colorado Springs or Denver. Office or home office may be an option in the future.

The Clinical Quality Program Manager (Medicaid) is responsible for serving as a liaison and overseeing the quality improvement activities/projects/programs for several Colorado counties in support of Behavioral Health. Primary duties may include, but are not limited to:

  • Works with Director to create quality measure strategies,  meetings, develops a quality plan, and ensures integration of quality into the overall business process.
  • Attends external quality meetings (i.e. State, Anthem, etc.)
  • Works with the clinical intervention team to design studies to identify barriers to medical interventions.
  • Travels to provider offices to assist with education and training as needed.
  • Ensures that study methodology is sound and appropriate reporting is in place.
  • Develops performance improvement plans and oversees the behavioral health 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.

Job Requirements


  • 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 clinical license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.
  • Experience in Behavioral Health field.
  • Quality Audit experience.
  • Strong PC skills.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.


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