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Medicaid Provider Quality Consultant - Home / Field based - must reside in SC - HEDIS and Prof License req’d (PS6314) in Columbia, SC at Anthem, Inc.

Date Posted: 5/14/2018

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: This position can be based anywhere in the state of South Carolina and will will be a combination of work from home and in the field working with our providers.
Travel: There will be pre-planned day, and overnight meetings (particularly during HEDIS Hybrid) in our Columbia, SC office and will require your attendance.
Work Hours: Can be 40 + hours some weeks with occasional weekend work and early evening hours.
The Practice Consultant (HEDIS Provider Educator) position is responsible for creating partnership relationships with providers; other initiatives; and implementing the concept of a Medical Home for our members to achieve this fully integrated and accountable system of care. Primary duties may include, but are not limited to:
  • Assesses current practice patterns, assets and challenges utilizing NCQA Standards, HEDIS audits, site reviews and medical records reviews.
  • In partnership with the PCP, evaluates results of the initial assessment.
  • Establishes a project plan with the practice that establishes goals and objectives for improvement.
  • Provides ongoing practice support and sustains the partnership.
  • Establishes regular meetings to track progress.
  • Improves the understanding and sensitivity to the unique needs of this population and the care givers.
  • Provides training to Provider staff; makes presentations to small and large groups.
  • May be required to present data and help create HEDIS specific provider material.
  • AS/BS in nursing or current, unrestricted professional, clinical license in the state of South Carolina; 5 years of managed care experience; 2 years of clinical experience; 2 years of professional presentations to small and large  audiences; or any  combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted professional, clinical license must be in South Carolina and may include LVN/LPN, RN, NP, PA, LCSW, LSW, LPC, Clinical Psychologist
  • Must have knowledge of HEDIS.
  • Proficient computer 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.