Anthem, Inc. Clinical Quality Analyst in Atlanta, Georgia
SHIFT: Day Job
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.
CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.
Responsible for developing, conducting, and analyzing quality studies according to criteria developed by management, external review organizations, and other regulatory agencies. Primary duties may include, but are not limited to:
Conducts provider on-site or webex meetings in coordination with network consultants to address and improve HEDIS/STARS performance and identified provider clinical quality issues.
Works on issues of diverse scope to drive HEDIS/STAR rating performance in which the analysis of data requires evaluation of identifiable factors and in accordance with department standards.
Analyses HEDIS/Star data, and data reporting to help drive and develop interventions.
Develops and monitors corrective actions.
Completes monthly progress/performance reports.
Generates scorecards for each market.
Other duties as assigned.
Requires a BA/BS in a health related field;
2 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted RN license in applicable state(s) required. BSN preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and 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.
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.