Anthem, Inc. Clinical Quality Program Admin in Nashville, Tennessee
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.
Summary: Responsible for overseeing the quality improvement activities/projects as outlined in the Quality Improvement (QI) work plan and as required by applicable law, regulations and accreditation standards. Will be supporting Well Child Interventions.
Hours: M-F 8 a.m. – 5 p.m. Remote – Must reside in TN.
Clinical Quality Program Admin
Ensures integration of quality into the overall business process. Performs assessments to identify gaps in the enterprise’s quality and technology assessment processes and initiates actions to correct these gaps.
Assures accuracy and completeness of input provided to internal and external QI committees and timely implementation of appropriate interventions.
Oversees the clinical quality improvement activities/projects to implement appropriate clinical interventions to improve the quality of care for members.
Assures compliance with corporate QI work plans.
Assures QI activities are relevant to the targeted population.
Assures compliance to Practice Guideline, Delegation and Continuity and Coordination of care Standards.
Maintains documentation of research programs to meet regulatory and Accreditation Standards.
Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of results.
May provide oversight to the Healthcare Effectiveness Data and Information Set (HEDIS) project team.
Supports Well Child Interventions
Requires a BS in health administration, nursing or related clinical field; 3 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 or certification in applicable field preferred (i.e. CPHQ). MS in the health field (i.e. Nursing) 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. 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. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.