Anthem, Inc. Director II-GBD Quality Management in Indianapolis, Indiana
SHIFT: Day Job
Responsible for developing, coordinating, communicating, and implementing a strategic clinical quality management and improvement program within the Indiana Medicaid plan. Will drive local improvement of HEDIS and CAHPS measures, driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program. He/she will work with the head of Medicaid quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA accreditation and compliance with regulatory agencies and other objectives. Significant oversight and interaction with the External Quality Review Organization (EQRO) in Indiana. This oversight includes mandated performance improvement plans and regulatory reporting.
Primary duties may include, but are not limited to:
Promotes broad understanding, communication, and collaboration with enterprise-wide leaders to ensure appropriate communication, integration, and utilization of best practices.
Oversees internal and state Quality Management (QM) Scorecard reporting.
Provides oversight for the member complaint, appeal process, privacy compliance process, or auditing of delegated services in assigned area.
Oversees Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.
Supports the External Quality Review Organization (EQRO) reporting and state audit processes. Provides leadership for QM representation in new business activities.
Serves as a representative to the State, attending state meetings and executing on deliverables.
Ensures compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.
Drives action plans and performance improvement around quality withholds from the state
Leads RFP response development and implementation of winning proposals
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a BA/BS in a health or business related field; 10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background. MSN, MPH, or MPA preferred. CQM experience in a Managed Care Organization strongly preferred. Population health management and/or clinical quality program development experience preferred.