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Manager Clinical Quality, Case Management (RN Req), Cerritos, PS3771 in Cerritos, CA at Anthem, Inc.

Date Posted: 4/2/2018

Job Snapshot

Job Description

Your Talent. Our Vision.  At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it’s a powerful combination.  It’s the foundation upon which we’re creating greater 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.

 
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..

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.

Job Requirements

Requires a BS in nursing or a health care related field; 3 years of managed care experience, including experience in program development and knowledge of the quality process and QI techniques; 2 years of supervisory experience; or any combination of education and experience, which would provide an equivalent background. MS in nursing or related clinical field and CPHQ preferred. Certification and/or license appropriate to field of specialty as required.

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 antheminc.com/careers. EOE. M/F/Disability/Veteran.