Dir II GBD Quality Mgmt - Plan

Anthem, Inc. Louisville, KY
Your Talent. Our Vision. At Anthem, Inc., it's apowerful combination, and the foundation upon which we're creating greater accessto care for our members, greater value for our customers, and greater healthfor our communities. Join us and together we will drive the future of healthcare.

Thisis an exceptional opportunity to do innovative work that means more to you andthose we serve atoneof America's leading health benefits companies and a Fortune Top 50 Company.

This position is in Louisville KY

Responsible for developing, coordinating,communicating, and implementing a strategic clinical quality management andimprovement program within assigned health plan. Primary duties may include,but are not limited to:

* Promotes broad understanding, communication, andcollaboration with enterprise-wide leaders to ensure appropriate communication,integration, and utilization of best practices.

* Oversees internal and stateQuality Management (QM) Scorecard reporting.

* Provides oversight for the membercomplaint, privacy compliance process, or auditing of delegated services inassigned area.

* Oversees Health Employer Data Information Sets (HEDIS) reportingand the development of action plans to achieve target improvement goals.

* Supports the External Quality Review Organization (EQRO) reporting and stateaudit processes.

* Represents the health plan at state meetings.

* Providesleadership for QM representation in new business activities.

* Ensure compliancewith National Committee for Quality Assurance (NCQA) standards or otheraccrediting bodies.

* Hires, trains, coaches, counsels, and evaluates performanceof direct reports

* Requires a BA/BS in a health or business relatedfield; 10 years of experience in a healthcare environment, including priormanagement experience; or any combination of education and experience, whichwould provide an equivalent background.

* MSN, MPH, or MPA preferred.

* CQMexperience in a Managed Care Organization and Medicaid health plan experience stronglypreferred.

* Population health management and/or clinical quality programdevelopment experience preferred.

Anthem, Inc. is ranked as one of America's MostAdmired Companies among health insurers by Fortune magazine and is a 2017 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran