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Anthem, Inc. Clinical Quality Program Director in Richmond, Virginia


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 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.

Location: Richmond, VA

The Corporate Clinical Quality Management team is seeking a clinical, data-oriented, HEDIS expert to join their team. We focus on developing and delivering clinical solutions that drive improvement in clinical outcomes for our most vulnerable populations.

Responsible for developing a national quality improvement strategy for a major line of business. Primary duties may include, but are not limited to: • Leads enterprise-wide quality strategy, interventions and programming with measurable improvements. • Identifies and integrates best practices into contract related strategies/programs. • Develops performance improvement plans and oversees the clinical quality improvement activities/projects. • Participates in the development, management, review and reporting of program outcomes for clinical quality programs. • Assures compliance with corporate Quality Improvement work plans. • Ensures research program documentation meets regulatory and Accreditation Standards. • Generates and Assures accurate and complete quantitative analysis of clinical data. • Leads department projects and mentors staff. • Prepares and presents program documents to senior management.


Requires a BS in health administration, nursing or a related clinical field; 5 years of health care quality or data analysis experience; or an equivalent combination of education and experience, which would provide an equivalent background. • Current unrestricted license or certification in an applicable field (i.e. CPHQ) or MS in the health field (i.e. Nursing) preferred. • Knowledge of state or assigned line of business needs and priority improvement areas required. • HEDIS Experience is strongly preferred, familiarity with primary source verification. • Results oriented with evidence based examples of driving HEDIS, Medicare Stars improvement.

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. 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 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.