Job Medicaid Quality Management Health Plan Dir – Anthem


SCHEDULE : Full-time

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change.

Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Build the Possibilities. Make an extraordinary impact.

The Medicaid Quality Management Health Plan Director is responsible for driving the development, coordination, communication, and implementation of strategic clinical quality management and improvement program within an assigned health plan.

Responsible for working with the regional head of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA accreditation, and compliance with regulatory agencies and other objectives.

Primary duties may include, but are not limited to :

Works with both internal and external customers to promote understanding of quality management 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 management skills.

Serves as a resource for the design and evaluation of process improvement plans / quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.

Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year-round medical record review, and overread processes.

Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.

Minimum Requirements

Requires BA / BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and 5 years of progressively responsible experience in a healthcare environment or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences

MS or advanced degree in a healthcare-related field (i.e. nursing, health education) or business is strongly preferred.

Previous experience working with NCQA, and HEDIS preferred.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, 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 Great Place To Work in 2021, is ranked as one of the 2021 Worlds Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion.

To learn more about our company and apply, please visit us at Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require an accommodation to participate in the job application process may contact ability for assistance.



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