Anthem, Inc Accreditation Manager, PBM PS16358 in Wallingford, Connecticut
Accreditation Manager, PBM PS16358
Location: United States
Field: Business Support
Requisition #: PS16358
Post Date: Jan 09, 2019
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.
Accreditation Manager, PBM
Responsible for managing all accreditation activities for multiple lines of business, regions of the company, standards set, and/or Corporate level which are necessary for attaining and maintaining accreditation from various accrediting organizations, such as URAC and NCQA.
Primary duties may include, but are not limited to:
Interfaces with internal and external clients, quality committees, and departments in the review of quality improvement data and in the implementation of appropriate interventions to effect improvement.
Manages the overall accreditation processes and resources required to successfully lead the team.
Evaluates, interprets and understands accreditation guidelines and manages the process for accreditation activities.
Identifies appropriate resources and accountabilities for project teams involved with accreditation.
Conducts the ongoing evaluation and interpretation of quality standards and accreditation standards to ensure compliance through documentation, including reporting and measurement studies/ methodologies.
Serves as expert resource to quality committees and business owners across the organization.
Leads and provides oversight of quality studies/projects.
Facilitates project management and develops comprehensive accreditation work plans by establishing deliverables, accountabilities, and timelines.
Performs quantitative and qualitative analysis of quality related data and reports activities, improvements, and provides recommendations to internal and external clients.
Collaborates with business partners and external entities on delegated arrangement activities.
Requires BA/BS in a health care field, and 3-5 years healthcare-related experience in addition to 3+ years’ experience in a QA/QI related position, project management, and strong quantitative, qualitative and analytical skills or any combination of education and experience, which would provide an equivalent background. Successful NCQA/URAC accreditation process completion and continuous process improvement experience in an NCQA/URAC setting highly preferred. Registered nurse highly preferred. URAC Pharmacy Management Benefit (PBM) experience highly preferred.
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.