Anthem, Inc. Clinical Quality Program Manager in Los Angeles, California
SHIFT: Day Job
This position may primarily work at home (virtual) and travel to local Orange County provider offices weekly (post-COVID environment).
Responsible for serving as a dedicated provider engagement consultant, managing CMS Stars Quality programs and Medicare Risk Adjustment documentation and coding accuracy initiatives within the Medicare Advantage line of business. Primary responsibilities may include, but are not limited to:
Facilitates monthly IPA, MSO and group level Quality (HEDIS/CAHPS/HOS) and Medicare Risk Adjustment strategy meetings. Develops an Action Plan, and ensures integration of Quality and Risk Adjustment metrics into the overall process.
Implements and maintains Quality and Medicare Risk Adjustment improvement actions for the largest, most complex state and provider programs.
Keeps in constant communication with practices for support, continuing education and ad-hoc discussions.
Prepares and participates in quarterly JOCs with presentation of high-level reporting to provider group leadership and follow-up on action items to completion.
Promotes engagement and oversight to ensure accurate and complete qualitative and quantitative analysis of HEDIS and Medicare Risk Adjustment data with sharing of results to appropriate provider team(s).
Assures compliance with Corporate Quality and Risk Adjustment work plans.
Maintains effective documentation of Quality and Risk Adjustment programs to meet regulatory and accreditation standards.
Recommends activities to enhance member satisfaction and improve overall health outcomes.
Requires a BS in health administration, nursing, or a related clinical field; 4 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field is preferred. HEDIS, Medicare risk adjustment experience strongly 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. 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 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.