Medicaid Quality Management Health Plan Director – Anthem, Inc.


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.

Title: Medicaid Quality Management Health Plan Director

Location: Colorado

(The position will start out as work from home but most likely transition to the office when offices re-open)

Status: Full-time, Salary, Bonus Potential

The Medicaid Quality Management Health Plan Director is an individual contributor role that 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.

+ No direct reports or supervisory duties


+ Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences)

+ 5 years progressively responsible experience in a Healthcare- Quality Management environment for a provider or payer

+ Extensive knowledge of Medicaid

+ Any combination of education and experience, which would provide an equivalent background.

+ Live in the state of Colorado

+ 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.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at 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.



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