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RN Clinical Quality Program Admin - Grand Prairie, Texas 136233 in Grand Prairie, TX at Anthem, Inc.

Date Posted: 2/9/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, 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.
 
This is an exceptional opportunity to do innovative work that means more to you and those we serve. 

 
The Clinical Quality Program Admin is responsible for overseeing the quality improvement activities/projects as outlined in the Quality Improvement (QI) work plan and as required by applicable law, regulations and accreditation standards. Primary duties may include, but are not limited to:
  • Ensures integration of quality into the overall business process.
  • Performs assessments to identify gaps in the enterprises quality and technology assessment processes and initiates actions to correct these gaps.
  • Assures accuracy and completeness of input provided to internal and external QI committees and timely implementation of appropriate interventions.
  • Oversees the clinical quality improvement activities/projects to implement appropriate clinical interventions to improve the quality of care for members.
  • Assures compliance with corporate QI work plans.
  • Assures QI activities are relevant to the targeted population.
  • Assures compliance to Practice Guideline, Delegation and Continuity and Coordination of care Standards.
  • 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.
  • May provide oversight to the Healthcare Effectiveness Data and Information Set (HEDIS) project team.

 

Job Requirements

  • Requires a BS in health administration, nursing or related clinical field; 3 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background.
  • Current Texas RN License required
  • Current unrestricted license or certification in applicable field preferred (i.e. CPHQ). MS in the health field (i.e. Nursing) preferred.
  • Must be willing to travel up to 50% within the state of Texas. 

 The person for this position needs to be located in the Dallas-Fort Worth, Texas area.  This is a remote position, but up to 50% travel will be required.
 
  Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 20167DiversityInc 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.