Anthem, Inc. Staff VP Accreditation - Beacon Health Options in Walnut Creek, California
SHIFT: Day Job
The SVP is responsible for strategic leadership and oversight of DBG accreditation and leading clinical adherence with regulatory areas. This position is accountable for establishing a best-in-class structure to ensure compliance with all accreditation and regulatory standards, as well as contractual requirements for each client. The role will have direct management of the accreditation department to complete all readiness reviews for surveys, create and revise policy and procedures, oversight of all matrix partners to ensure all standards/requirements are met. The SVP leads the development and execution of the Accreditation and compliance strategic plan; oversees operations and management of the Accreditation team; structures and aligns all accreditation and surveys across the regions; and, develops measurement strategies and assigns performance targets in order to assess the effectiveness of Quality activities. This role will be responsible for providing leadership and oversight of the accreditation departments and lines of business for Beacon Health Options, and leading inter-departmental collaborative work to execute and ensure compliance across all standards. The SVP is a thought-leader who demonstrates critical thinking and planning to drive all accreditation activities. Will be tasked with expanding other NCQA accreditations and national certifications.
The candidate to fill this role must be able to demonstrate command of Accreditation knowledge and expertise, experience, and leadership skills. This role will be required to interface with the Senior Level counterpart at the client, accreditation agencies, regulatory and compliance entities, and internal Executive Leadership.
Primary duties may include, but are not limited to:
Leads systemic and process implementation of accreditation standards and programs.
Provides guidance and direction to corporate stakeholders and health plans to meet accreditation requirements. Monitors and ensures compliance to all state, federal, and accreditation requirements.
Ensures programs are compliant with regulatory and accreditation requirements and support the overall regulatory compliance, NCQA, and URAC accreditations, as well as HEDIS/STARs performance.
Leads business unit SOX compliance.
Supports Anthem accreditation team.
Expands national certifications and accreditations Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
Requires Masters degree or Ph.D. in Public Health Public Administration Management, Psychology, Social Work, or other related fields that meet the job requirements and/or equivalent experience
A minimum of 8 years experience in healthcare quality improvement
A minimum of 5 years experience in managed care management,
A minimum of 10 years of management experience; or any combination of education and experience, which would provide an equivalent background.
Experience with NCQA/URAC/CMS accreditation preparation and auditing, including the analysis of HEDIS performance measures is also required.
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 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.