Director II Quality Management
Description SHIFT:
Day Job SCHEDULE:
Full-time 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 care companies and a Fortune Top 50 Company. Director II Quality Management Responsible for developing, coordinating, communicating, and implementing a strategic clinical quality management and improvement program within assigned health plan. Primary duties may include, but are not limited to:
Promotes broad understanding, communication, and collaboration with enterprise-wide leaders to ensure appropriate communication, integration, and utilization of best practices.
Oversees internal and state Quality Management (QM) Scorecard reporting.
Provides oversight for the member complaint, appeal process, privacy compliance process, or auditing of delegated services in assigned area.
Oversees Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.
Supports the External Quality Review Organization (EQRO) reporting and state audit processes. Provides leadership for QM representation in new business activities.
Ensure compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.
Hires, trains, coaches, counsels, and evaluates performance of direct reports. Qualifications Requirements
Requires a BA/BS in a health or business related field; 10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background. Preferred Qualifications
4 or more years of experience overseeing HEDIS/Quality programs
4 or more years of leadership experience
Experience with clinical audits, hybrid abstraction and other QI areas We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For , is ranked as one of the 2020 World's Most Admired Companies among health insurers by Fortune magazine, and a 2020 America's Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions. REQNUMBER:
PS61311
Salary Range:
$200K -- $250K
Minimum Qualification
Quality ManagementEstimated Salary: $20 to $28 per hour based on qualifications.
Day Job SCHEDULE:
Full-time 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 care companies and a Fortune Top 50 Company. Director II Quality Management Responsible for developing, coordinating, communicating, and implementing a strategic clinical quality management and improvement program within assigned health plan. Primary duties may include, but are not limited to:
Promotes broad understanding, communication, and collaboration with enterprise-wide leaders to ensure appropriate communication, integration, and utilization of best practices.
Oversees internal and state Quality Management (QM) Scorecard reporting.
Provides oversight for the member complaint, appeal process, privacy compliance process, or auditing of delegated services in assigned area.
Oversees Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.
Supports the External Quality Review Organization (EQRO) reporting and state audit processes. Provides leadership for QM representation in new business activities.
Ensure compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.
Hires, trains, coaches, counsels, and evaluates performance of direct reports. Qualifications Requirements
Requires a BA/BS in a health or business related field; 10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background. Preferred Qualifications
4 or more years of experience overseeing HEDIS/Quality programs
4 or more years of leadership experience
Experience with clinical audits, hybrid abstraction and other QI areas We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For , is ranked as one of the 2020 World's Most Admired Companies among health insurers by Fortune magazine, and a 2020 America's Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions. REQNUMBER:
PS61311
Salary Range:
$200K -- $250K
Minimum Qualification
Quality ManagementEstimated Salary: $20 to $28 per hour based on qualifications.
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