Anthem Inc. Medical Jobs

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Anthem, Inc. Director Clinical Quality in Flushing, New York

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 benefits companies and a Fortune Top 50 Company.

There are 2 Director positions available. Please read both descriptions.

Location: Any Anthem office once we return to offices.

Position 1

Responsible for working with the Staff Vice President to direct the clinical quality initiatives for Medicaid including; medical record abstraction and research, gap closure, Hybrid HEDIS SME, off-shore and third party vendors, and other duties as assigned. Primary duties may include, but are not limited to: HEDIS Medical Record abstraction activities, oversite of vendors, working with both internal and external customers to promote an understanding of HEDIS activities and objectives within the company and to prioritize departmental projects according to Anthem corporate, regional, and departmental goals. Maintains expert knowledge of current industry standards, quality improvement activities, and strong medical record management skills. Assures the training and continuing education of staff regarding standards and guidelines, including NCQA and HEDIS. Hires, trains, coaches, counsels, and evaluates the performance of direct reports

Responsible for working with the Staff Vice President to direct the clinical quality initiatives including; medical record pursuit, provider outreach, phone center operations, copy services/third party vendors, and other duties as assigned. Primary duties may include, but are not limited to: HEDIS Medical Record Pursuit activities, oversite of copy service vendors, working with both internal and external customers to promote an understanding of HEDIS activities and objectives within the company and to prioritize departmental projects according to Anthem corporate, regional, and departmental goals. Maintains expert knowledge of current industry standards, quality improvement activities, and strong medical record management skills. Assures the training and continuing education of staff regarding standards and guidelines, including NCQA and HEDIS. Hires, trains, coaches, counsels, and evaluates the performance of direct reports

Qualifications

Position 1

Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and 5 years progressively responsible management experience in a health care environment or any combination of education and experience, which would provide an equivalent background. MS or advanced degree in a health care related field (i.e. nursing, health education) or business strongly preferred. Previous experience working with NCQA, and HEDIS preferred. Previous HEDIS Medical Record Abstraction operations highly preferred.

Position 2

Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and 5 years progressively responsible management experience in a health care environment or any combination of education and experience, which would provide an equivalent background. MS or advanced degree in a health care related field (i.e. nursing, health education) or business strongly preferred. Previous experience working with NCQA, and HEDIS preferred. Previous HEDIS Medical Record Pursuit operations highly preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

REQNUMBER: PS41801

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