2 Jobs Head Of Quality Management Available

Medicaid QM Health Plan Director

Posted on:
06/21/2021

Anthem, Inc

Remote, United States

Description SHIFT: Day JobSCHEDULE: Full-time Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon whic. . .

Posted on:
06/21/2021
Apply Before:
07/19/2021

Head Of Plant Quality Management

Posted on:
06/21/2021

Datwyler Middle East FZE

Middletown, DE, United States

The Sealing Solutions division is a leading supplier of custom sealing solutions to global industry segments, such as the health care, automotive, con. . .

Posted on:
06/21/2021
Apply Before:
07/19/2021

Medicaid QM Health Plan Director

Anthem, Inc

Remote, United States Apply Now
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Description

SHIFT: Day JobSCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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 QM Health Plan

Required Location: Nebraska

Status: Full-time, Salary, Bonus Potential

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

Qualifications

  • BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences)
  • RN, PA or above licensure for the state of Nebraska
  • 5 years progressively responsible experience in a health care environment
  •  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.

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 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.