Director Clinical Quality

Description SHIFT: Day JobSCHEDULE: Full-timeYour 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.There are 2 Director positions available. Please read both descriptions.Location: Any Anthem office once we return to offices.Position 1Responsible for

working with the Staff Vice President to direct the clinical quality

initiatives for Medicaid

including; medical record abstraction

and research, gap closure, Hybrid HEDIS SME, off-shore and third party

vendors, and other duties as assigned. Primary duties may include, but

are not limited to: HEDIS Medical Record abstraction activities, oversite of vendors,

working with both internal and external customers to promote an understanding

of HEDIS activities and objectives within the company and to prioritize

departmental projects according to Anthem corporate, regional, and departmental

goals. Maintains expert knowledge of current industry standards, quality

improvement activities, and strong medical record management skills. Assures

the training and continuing education of staff regarding standards and

guidelines, including NCQA and HEDIS. Hires, trains, coaches, counsels, and

evaluates the performance of direct reportsResponsible for

working with the Staff Vice President to direct the clinical quality

initiatives including; medical record pursuit, provider outreach, phone center operations, copy

services/third party vendors, and other duties as assigned.

Primary duties may include, but are not limited to: HEDIS Medical Record Pursuit activities,

oversite of copy service vendors, working with both internal and external

customers to promote an understanding of HEDIS activities and objectives within

the company and to prioritize departmental projects according to Anthem

corporate, regional, and departmental goals. Maintains expert knowledge of

current industry standards, quality improvement activities, and strong medical

record management skills. Assures the training and continuing education of

staff regarding standards and guidelines, including NCQA and HEDIS. Hires,

trains, coaches, counsels, and evaluates the performance of direct reportsQualifications Position 1Requires BA/BS in a clinical or health care field (i.e.

nursing, epidemiology, health sciences) and 5 years progressively responsible

management experience in a health care environment or any combination of

education and experience, which would provide an equivalent background. MS or

advanced degree in a health care related field (i.e. nursing, health education)

or business strongly preferred. Previous experience working with NCQA, and

HEDIS preferred. Previous HEDIS Medical Record Abstraction operations highly preferred. Position 2Requires BA/BS in a clinical or health care field (i.e.

nursing, epidemiology, health sciences) and 5 years progressively responsible

management experience in a health care environment or any combination of

education and experience, which would provide an equivalent background. MS or

advanced degree in a health care related field (i.e. nursing, health education)

or business strongly preferred. Previous experience working with NCQA, and

HEDIS preferred. Previous HEDIS Medical Record Pursuit operations 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.REQNUMBER: PS41801