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Dir Clin Quality Management in Buffalo, NY at Anthem, Inc.

Date Posted: 11/30/2018

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.

Responsible for overseeing the development of quality improvement strategies for the enterprise and/or clinical program development for population-based clinical quality measures. Primary duties may include, but are not limited to:
  •  Directs the development of a local quality plan and the integration of quality into the overall business process.
  •  Evaluates industry best practices, medical research, and other resources to develop clinical programs and tools which facilitate and support quality, cost-effective care.
  •  Develops and implements an annual plan detailing the strategies, programs and tools to be implemented.
  •  Assures compliance with corporate QI work plans.
  •  Assures that all QI activities are relevant to the needs of targeted population.  
  • Responsible for health plan handling grievances and appeals and for maintaining regulatory compliance in this area. 
  •  Maintains 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 results of data analysis.
  • Tracks program performance and results.
  • Works with both internal and external customers to promote understanding of health services activities and objectives and to prioritize projects according to corporate, regional, and departmental goals.
  •  Hires, trains, coaches, counsels, and evaluates performance of direct reports. 

  • Requires a BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences); 5 years of management experience in a health care environment; or any combination of education and experience, which would provide an equivalent background.
  •  MS or advanced degree in a health care related field (i.e. nursing, health education) or business preferred.
  •  Previous experience working with NCQA, and HEDIS preferred.
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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