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Anthem, Inc. Clinical Quality Program Administrator in San Jose, California


SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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.

California, Nevada, Oregon, Washington - must be able to work primarily in Pacific Standard Time business hours

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.

Primary duties may include, but are not limited to:

  • Ensures integration of quality into the overall business process.

  • Working knowledge and experience managing process improvement programs (PIPs).

  • Working knowledge and experience with HEDIS performance measures and population health initiatives, particularly Breast Cancer Screenings, Diabetes, Hypertension, and Prenatal and Postpartum care.

  • May provide oversight to the Healthcare Effectiveness Data and Information Set (HEDIS) project team.

  • 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.

  • Working knowledge of data analytics and mid-level experience with data analysis utilizing industry standard application tools.

  • Cross functional collaboration with multidisciplinary teams. Serves as a subject matter expert (SME) on quality interventions and can effectively communication strategic corporate and health plan quality initiatives.


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.

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: PS58418-California