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Anthem, Inc. Program Consultant – Medicare in New York, New York


SHIFT: Day Job

SCHEDULE: Full-time

At Empire BlueCross BlueShield, a proud member of the Anthem, Inc. family of companies, serving our communities for over 85 years. 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.

Empire’s commitment to inclusion and diversity makes us a stronger organization. Our culture is essential to attracting talent that understands and connects with our consumers. It creates spaces where different perspectives and experiences are valued; it lets us develop innovative thinking and unifies our associates behind our mission—to materially and measurably improve the whole health of all New Yorkers and make healthcare simpler.

Empire’s Whole Health proposition is committed to protecting an individual’s complete health and wellness. Our inclusivity is the foundation to serve and support our diverse New York communities.

Program Consultant – Medicare

Location: New York City, NY

Positions are able to work remotely; preferred applicants who live in NY; will consider nearby locations for the most qualified applicant

The Program Consultant is responsible for the development and ongoing management of one or more multi-year external client facing programs with primary focus on HEDIS, risk adjustment, and overall Medicare Value Based performance. The program manager is also responsible for provider education, engagement, data sharing, goal setting and monitoring of tangible action items relating to performance. Must be able to collaborate with all internal and external stake holders involved in managing provider relationships within the market and must be recognized as a subject matter expert. Employs high level critical thinking skills, superior interpersonal communications skills, as well as a track record of improving provider performance.

Primary duties may include, but are not limited to:

  • Manages and coordinates the development and implementation of provider facing programs pertaining to Stars, HEDIS, and Risk Adjustment; monitors provider performance and engagement related to established metrics and key performance indicators.

  • Acts as collaborator for the creation and maintenance of provider specific action plans to establish and monitor provider specific goals.

  • Oversees the deployment and ensures appropriate provider understanding and engagement of Stars, HEDIS and Risk Adjustment regional and corporate initiatives with assigned providers.

  • Collaborate with internal stakeholders to deliver desired results.

  • Maintains awareness of market and industry trends.


Required Qualifications:

  • Requires a BA/BS in a related field; 3-5 years of experience in external client facing program management; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:

  • For the Behavioral Health organization, lived experiences with behavioral health programs is strongly preferred.

  • Graduate degree, professional designation related to field or project management experience 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 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: PS54324-New%20York