Anthem Clinical Quality/Compliance Admin-FEP-134472 in Portland, Maine

/ 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.

The Clinical Quality/Compliance Admin r esponsible for coordinating Quality Management (QM) activities related to compliance and accreditation for an assigned SBU. Primary duties may include, but are not limited to:

  • Develops and maintains pertinent compliance plans.

  • Monitors adherence to plans and prepares status reports.

  • Conducts audits, identifies training and communication needs, and implements related programs.

  • Ensures all policies and procedures are updated as legislation or accreditation standards change.

  • Implements standardization of procedures and documentation within SBU.

  • Develops and delivers executive level presentations and represents senior management on compliance issues and related committees.

    It is preferred that this position may work from the Indianapolis, IN; Roanoke, VA; Richmond, VA or Albany, NY offices, but, can work any Anthem location. May be able to work remote.

  • Requires a BA/BS; 3 years of compliance, audit or quality improvement experience; or any combination of education and experience, which would provide an equivalent background.

  • Experience with regulatory/accreditation audits and knowledge of regulatory/accreditation standards in a health or managed care environment is required.

  • Ability to travel overnight maybe required.

  • RN or LPN/LVN preferred.

  • Case management disease management, utilization management and/or medical review experience is preferred.

  • Must have knowledge of NCQA.

  • Experience with WMDS, ECC, Tri-Med and HRS is strongly preferred.

  • Excellent computer skills/knowledge is required.

/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran. /

Job Medical

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Clinical Quality/Compliance Admin-FEP-134472

Location: maine-Portland

Requisition ID: 134472