Anthem, Inc. Clinical Quality Program Admin (Quality of Care) - Richmond, VA in Richmond, Virginia
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 benefits companies and a Fortune Top 50 Company.
Location: Richmond, VA Office (Please note that due to Coronavirus we are allowing this position to work remote until we determine it is safe for associates to return to the Richmond office.)
The Clinical Quality Program Admin is responsible for overseeing the quality improvement activities/projects as outlined in the Quality Improvement (QI) work plan and as required by applicable law, regulations and accreditation standards. To systematically identify, investigate, and resolve Quality of Care issues through the complaint/grievance process and other corporate and health plan mechanisms to ensure quality and appropriateness of care and services rendered.
Primary duties may include, but are not limited to:
Ensures integration of quality into the overall business process.
Performs assessments to identify gaps in the enterprises quality and technology assessment processes and initiates actions to correct these gaps.
Assures accuracy and completeness of input provided to internal and external QI committees and timely implementation of appropriate interventions.
Oversees the clinical quality improvement activities/projects to implement appropriate clinical interventions to improve the quality of care for members.
Assures compliance with corporate QI work plans.
Assures QI activities are relevant to the targeted population.
Assures compliance to Practice Guideline, Delegation and Continuity and Coordination of care Standards.
Maintains documentation of research programs to meet regulatory and Accreditation Standards.
Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of results.
May provide oversight to the Healthcare Effectiveness Data and Information Set (HEDIS) project team.
BS in health administration, nursing or related clinical field preferred; 3 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background.
Current active, unrestricted RN license in the state of Virginia required.
Clinical medical record review experience required
Intermediate to Advanced skills in Microsoft Excel required
Highly skilled in reporting development and data analysis required
Project Management, including meeting facilitation, experience required
Managed care experience preferred
Quality of Care experience preferred
Regulatory compliance experience preferred.
Compliance audit experience preferred.
Additional skills relevant for this position: problem solving, researching, analyzing information, highly organized, team player, ability to perform multiple functions.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. REQNUMBER: PS38308