Anthem, Inc. Population Health Clinical Program Development Manager in Lexington, Kentucky
SHIFT: Day Job
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.
The Corporate Clinical Quality team is seeking an energetic, detailed, action driven associate to join our team as a Clinical Program Development Manager. This resource will be responsible for managing internal and external vendor relationships to execute clinical interventions aimed at ensuring members are receiving services to close clinical HEDIS gaps.
This is an office based position- Any Anthem location. Must be located within a commutable distance to an Anthem Office.
This person will be responsible for the following:
• Creating business cases, cost and metric justifications for clinical interventions. Answering the questions of why the programs are beneficial to our members and what we can expect to achieve from implementing the program.
• Working closely with procurement and sourcing to create Statements of Work outlining key performance metrics, asking detailed vendor questions around capabilities and expectations.
• Maintains effective documentation of research programs to meet regulatory and Accreditation Standards.
• Deep understanding of process flows, sequential steps, and critical path milestones.
• Familiar and accustomed to reporting out project status and details, managing risks and communicating with manager on projects.
• Create aggressive metrics and achieve performance metrics for assigned programs.
• Understand and calculate expected Stars/rate lift from intervention.
• Work closely with evaluation team to ensure proper control groups are established and data is available. Ensures accurate and complete quantitative analysis of clinical data and presentation of data analysis results.
• Working closely with various stakeholders across matrixed organization such as: (Finance, Actuarial, Procurement, Strategy, Reporting, Regulatory, Compliance).
• Assures timely and accurate project deliverables.
• Manages and promotes project management efficiency and improvements.
• Embraces and researches external industry and market trends.
Must be well versed in the following:
• HEDIS, Medicare, STARs measurement
• Mathematics – must be able to complete formulas and data analysis using Excel and Tableau to calculate cost estimates, business value
• Project management of large complex programs.
• PowerPoint – creating presentations on business case, progress, and outcomes.
• Visio – must be able to create detailed process flows around process steps and data flows
• Member behaviors, ensuring programs achieve optimal feedback from our members. Must keep Anthem’s members in mind at all times.
• Failure Modes Effect Analysis – ensuring mitigation of project mishaps are identified and plan is in place to prevent them.
• Customer service focused
• Compliance focused
Requires a BA in business, public health, nursing, epidemiology biostatistics, or related field; 5 years of experience involving analyses of health care data and clinical program development; or any combination of education and experience, which would provide an equivalent background. MS in public health, health services administration, nursing, or business administration preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.