Anthem, Inc. Clinical Quality Analyst Senior (Remote) in San Jose, California
SHIFT: Day Job
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.
CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.
Responsible for developing and conducting more complex quality studies by analyzing data, validating data accuracy, and evaluating / defining processes according to department criteria, external review organizations, and other regulatory agencies. Primary duties may include, but are not limited to:
Researches provider clinical quality issues and assists with identifying root cause analysis and corrective measures
Works on more complex studies in which analysis of situations or data requires an in-depth evaluation of various factors including processes and QM program / interventions
Completes monthly or quarterly progress/performance reports or presentations.
Provides feedback to practitioners on performance.
Prepares department for oversight audits.
Prepares corrective action plans in response to oversight body's request.
Conducts audits of QM processes and data files. Writes policies and procedures, defines and / or creates processes.
Coordinates the collection and organization of information and documents according to department criteria, external review organizations, and other regulatory agencies
Participates in development and design of audit tools, policies and procedures, and provider manuals
Completes quarterly Quality Management (QM) coalition reports for submission to regulatory bodies.
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.
Requires a BA/BS in a health or business related field;
At least 3 years required or 5 years preferred of clinical, managed care or clinical quality improvement experience; or any combination of education and experience, which would provide an equivalent background.
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 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.