Anthem, Inc. Director I, GBD Quality Management in Columbia, South Carolina
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.
(This position will be located in our Columbia, SC office. Due to the current COVID-19 (coronavirus) pandemic, this position will require you to work remotely from your home with the expectation to return to a regular, in-office work environment.)
The Director I, GBD Quality Management role is responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan. Primary duties may include, but are not limited to:
Directs and provides leadership for implementing, monitoring and evaluating the Quality Management Program for the health plan.
Promotes understanding, communication, and coordination of the quality management program.
Directs and provides leadership for compliance with National Committee for Quality Assurance (NCQA) standards.
Provides leadership for the interpretation of results and development of improvement action plans arising from provider and member satisfaction surveys.
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.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Responsible for and must have experience and knowledge leading teams through intervention development and monitoring, process improvement, performance or quality improvement projects (PIPs/QIPs), provider and member quality strategy, and vendor monitoring.
Collaborates with external customers and key stakeholders such as the state, external quality review organization (EQRO), provider groups, community organizations etc.
Requires a BA/BS in a health or business related field; 8 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background.
MSN, MPH, or MPA preferred.
Current clinical license preferred.
CQM experience in a Managed Care Organization preferred.
Certification as a Certified Professional in Health Care Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers 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.