Anthem Clinical Quality Program Administrator (RN with NCQA and HEDIS experience Preferred) - Richmond, VA - 131186 in Richmond, Virginia

/ 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 benefits companies and a Fortune Top 50 Company.

Clinical Quality Program Administrator – Richmond, VA

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:

  • Oversees the nonclinical and/or clinical quality improvement activities/projects/tasks to implement appropriate clinical and/or nonclinical interventions to improve the quality of care for members.

  • Ensures integration of quality into the overall business process.

  • Performs assessments to identify gaps in the enterprises 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.

  • 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 and nonclinical quality data and presentation of results.

  • Assists with Healthcare Effectiveness Data and Information Set (HEDIS) project team activities.

  • Requires a BS in health administration, nursing, psychology or related health sciences field; 3 years of health care, quality, managed care experience and data analysis experience; or any combination of education and experience, which would provide an equivalent background.

  • MS in the health field (i.e. Nursing, Psychology or other health sciences related degree) preferred.

  • HEDIS experience or education highly preferred.

  • Project Management experience or in process preferred.

  • Willing to complete Six Sigma Yellow and Green Belt training courses.

  • At least one year in developing dashboards experience preferred.

  • Willing to travel at least 10% across the State.

  • Current unrestricted license or certification in applicable field preferred (i.e. RN or CPHQ).

/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /

Job Medical

Title: Clinical Quality Program Administrator (RN with NCQA and HEDIS experience Preferred) - Richmond, VA - 131186

Location: VA-Richmond

Requisition ID: 131186