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Anthem, Inc. Medicare Provider Care Consultant in Buffalo, New York


SHIFT: Day Job

SCHEDULE: Full-time

At Empire BlueCross BlueShield, a proud member of the Anthem, Inc. family of companies, serving our communities for over 85 years. 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.

Empire’s commitment to inclusion and diversity makes us a stronger organization. Our culture is essential to attracting talent that understands and connects with our consumers. It creates spaces where different perspectives and experiences are valued; it lets us develop innovative thinking and unifies our associates behind our mission—to materially and measurably improve the whole health of all New Yorkers and make healthcare simpler.

Empire’s Whole Health proposition is committed to protecting an individual’s complete health and wellness. Our inclusivity is the foundation to serve and support our diverse New York communities.

Medicare Provider Care Consultant

Location: New York Metropolitan Area

Positions will be remote with some local travel

The Medicare Provider Care Consultant is responsible for providing support to providers to improve the effectiveness and efficiencies of provider practices for Stars and HEDIS.

Primary duties may include, but are not limited to:

  • Obtain and analyze quality metrics and reports for care opportunities, support practice implementation of Quality improvement opportunities, identify action plans for providers to implement to improve quality and the patient experience.

  • Actively participate in developing program recommendations and action plans (Internal).

  • Support the efforts of providers and practice teams on office based care delivery interventions resulting in care gap closures and improved health outcomes for patients.

  • Engage with network relations representatives to meet provider and practice service needs.

  • Provide education for practices to develop expertise with metrics and data review for quality improvement.

  • May participate in various community and multi-department committees to assure effective program implementation.

  • Track progress of program and prepare status reports to management or senior management and providers.

  • Maintain up to date knowledge on Patient Centered medical Home, Care Delivery System Redesign, Accountable Care Organizations, HEDIS, and STARS.


Minimum Requirements:

  • Requires a BA/BS; 3 years health care experience; or any combination of education and experience, which would provide an equivalent background.

  • Ability to travel locally up to 75% of the time.

Preferred Qualifications:

  • Physician environment experience in practice transformation/quality improvement, ambulatory care setting quality and efficiency metrics, and electronic health records.

  • Experience with STARS and HEDIS.

  • Experience working with providers and provider relations.

  • Must be comfortable presenting to large groups of professionals.

  • Proficiency in MS Office required, particularly MC Excel and MS PowerPoint.

  • Proficiency with Tableau.

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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.

REQNUMBER: PS57663-New%20York