Medicaid QM Health Plan Director | Amerigroup



SHIFT: Day Job

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.

The Medicaid QM Health Plan Director is responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within 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 over read processes.
  • Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.


  • Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and 5 years progressively responsible 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.


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