Anthem, Inc. Practice Consultant/RN Maternal Child Health in Lexington, Kentucky
SHIFT: Day Job
Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, 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.
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.
Practice Consultant/RN Maternal Child Health
*This is a Work at Home position
Location preferred: Kentucky/Lexington area
As a member of the Government Business Division, Maternal Child Services Corporate team the successful candidate will work collaboratively with select Health Plans in the East and/or South region of the United States to improve Obstetrics provider collaboration and quality member outcomes. Additionally, in collaboration with health plan Quality, Provider Relations and Provider Network development teams, the successful candidate will work closely with group and individual provider offices to provide information on Maternal Child Services programs, share provider profile (score card) results and Obstetrics Provider-Quality Improvement Program (OBQIP) reports.
Summary: The Practice Consultant is responsible for creating and implementing quality provider and member initiatives within assigned markets. Through establishing a collaborative partnership with providers, quality initiatives will focus on driving performance guarantee outcomes and NCQA accreditation.
Primary duties may include, but are not limited to:
Assesses quality performance of the primary care practice, identify opportunities for improvement, asses current practice patterns, assets and challenges, NCQA Standards, HEDIS audits, medical records reviews and site reviews
In partnership with the OB, evaluates quality opportunities for implementation by establishing a project plan with the practice that identifies goals and objectives for improvement
Provides ongoing practice support and sustains the partnership
Establishes regular meetings to track progress
Improves the understanding and sensitivity to the unique needs of this population and the care givers
Successful candidate will be adept at data interpretation with ability to develop and implement a quality plan to achieved
Requires an AS/BS in nursing; 5 years of managed care experience; 2 years of clinical experience; 2 years of professional presentations to small and large audiences; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted clinical license appropriate to field of specialty (LVN/LPN, RN, NP, PA, LCSW, LSW, etc.) as required. RN strongly preferred.
Must be able to travel 75% of the time within the assigned territory (No travel during Covid pandemic).
Seeking energetic, self-directed candidates with an outgoing personality and great communication and presentation skills.
Experience with provider operations preferred.
Experience with prenatal care/OB strongly preferred.
Experience with maternal and child health required.
HEDIS experience also preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran.