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Anthem, Inc. RN Maternal Child Health Practice Consultant in Modesto, California

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, 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.

As a member of the Government Business Division, Maternal Child Services Corporate team the successful candidate will work collaboratively with select Health Plans in the East and/or South region of the United States to improve Obstetrics provider collaboration and quality member outcomes. Additionally, in collaboration with health plan Quality, Provider Relations and Provider Network development teams, the successful candidate will work closely with group and individual provider offices to provide information on Maternal Child Services programs, share provider profile (score card) results and Obstetrics Provider-Quality Improvement Program (OBQIP) reports.

This is a field-based position that will require 75% of travel within the central California area.

The Practice Consultant is responsible for creating and implementing quality provider and member initiatives within assigned markets. Through establishing a collaborative partnership with providers, quality initiatives will focus on driving performance guarantee outcomes and NCQA accreditation.

Primary duties may include, but are not limited to:

  • Assesses quality performance of the primary care practice, identify opportunities for improvement, asses current practice patterns, assets and challenges, NCQA Standards, HEDIS audits, medical records reviews and site reviews

  • In partnership with the OB, evaluates quality opportunities for implementation by establishing a project plan with the practice that identifies goals and objectives for improvement

  • Provides ongoing practice support and sustains the partnership

  • Establishes regular meetings to track progress

  • Improves the understanding and sensitivity to the unique needs of this population and the care givers

  • Successful candidate will be adept at data interpretation with ability to develop and implement a quality plan to achieved

Qualifications

Minimum Requirements:

  • AS/BS in nursing; Bachelors in nursing (BSN) strongly preferred.

  • Minimum 5 years of managed care experience; minimum 2 years of clinical experience; minimum 2 years of professional presentations to small and large audiences; or any combination of education and experience, which would provide an equivalent background.

  • Current, unrestricted RN license in the state of CA required

    Preferred Requirements:

  • Must be able to travel 75% of the time within the assigned territory

  • Seeking energetic, self-directed candidates with an outgoing personality and great communication and presentation skills

  • Experience with provider operations preferred

  • Experience with maternal and child health required

  • HEDIS experience also preferred

    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 careers.antheminc.com. 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: PS58699-2338

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