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Anthem, Inc. Director Quality Management Plan - Medicaid in Mason, Ohio


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 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.

Title: Director I - Quality Management Plan - Medicaid

Location: Will need to work from Ohio, preferrably Columbus, OH region.

Responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan.

  • The primary functions of the QI Director are to:

  • Develop and manage the MCO's portfolio of improvement projects, including ensuring impact at a population level and identifying and prioritizing initiatives to align with ODM's Quality Strategy;

  • Oversee MCO improvement teams and coordinate QI training for MCO staff;

  • Reinforce the application of QI tools and methods within MCO improvement projects and initiatives; and

  • Ensure that learning from all improvement projects and initiatives are shared with Ohio Department of Medicaid and ODM's contracted managed care entities.

    Duties may also include but are not limited to:

  • Directs and provides leadership for implementing, monitoring and evaluating the Quality Management Program for the health plan.

  • Promotes understanding, communication, and coordination of the quality management program.

  • Directs and provides leadership for compliance with National Committee for Quality Assurance (NCQA) standards.

  • Provides leadership for the interpretation of results and development of improvement action plans arising from provider and member satisfaction surveys.

  • Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.

  • Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year-round medical record review, and over read processes.

  • Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements. Hires, trains, coaches, counsels, and evaluates performance of direct reports.


  • BA/BS in a health or business-related field with 8 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 preferred.

  • Be an Ohio-licensed registered nurse, physician, or physician's assistant, or be certified as a Certified Professional in Health Care Quality by the National Association for Healthcare Quality (NAHQ), Certified QI Associate by the American Society for Quality, and/or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers prior to employment or within six months of the date of hire;

  • Have experience in quality management and quality improvement as specified in 42 CFR 438.206 through 438.370; and

  • Report directly to the Medical Director/CMO.

    Applicable to Colorado Applicants Only

    Annual Salary Range*: $109,427 - 136,784

    Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.

    • The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

    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: PS52446-Mason-Mason